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Assessment of Nociception and Pain in Participants in an Unresponsive or Minimally Conscious State After Acquired Brain Injury: The Relation Between the Coma Recovery Scale–Revised and the Nociception Coma Scale–Revised

Published:April 10, 2018DOI:https://doi.org/10.1016/j.apmr.2018.03.009

      Abstract

      Objectives

      To investigate the relation between consciousness and nociceptive responsiveness (ie, Nociception Coma Scale–Revised [NCS-R]), to examine the suitability of the NCS-R for assessing nociception in participants with disorders of consciousness (DOC), and to replicate previous findings on psychometric properties of the scale.

      Design

      Specialized DOC program.

      Setting

      Specialized DOC program and university hospitals.

      Participants

      Participants (N=85) diagnosed with DOC.

      Interventions

      Not applicable.

      Main Outcome Measures

      We prospectively assessed consciousness with the Coma Recovery Scale–Revised (CRS-R). Responses during baseline, non-noxious, and noxious stimulations were scored with the NCS-R and CRS-R oromotor and motor subscales.

      Results

      CRS-R total scores correlated with NCS-R total scores and subscores. CRS-R motor subscores correlated with NCS-R total scores and motor subscores, and CRS-R oromotor subscores correlated with NCS-R total scores as well as verbal and facial expression subscores. There was a difference between unresponsive wakefulness syndrome and minimally conscious state in the proportion of grimacing and/or crying participants during noxious conditions. We replicated previous findings on psychometric properties of the scale but found a different score as the best threshold for nociception.

      Conclusions

      We report a strong relation between the responsiveness to nociception and the level of consciousness. The NCS-R seems to be a valuable tool for assessing nociception in an efficient manner, but additional studies are needed to allow recommendations for clinical assessment of subjective pain experience.

      Keywords

      List of abbreviations:

      CRS-R (Coma Recovery Scale–Revised), DOC (disorders of consciousness), MCS (minimally conscious state), NCS-R (Nociception Coma Scale–Revised), UWS (unresponsive wakefulness syndrome)
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