Marco Iosa (Italy)
IRCCS FONDAZIONE SANTA LUCIA .Author Of 1 Presentation
NOCICEPTION COMA SCALE-REVISED (NCS-R) WITH PERSONALIZED PAINFUL STIMULATION VERSUS STANDARD STIMULUS IN NON-COMMUNICATIVE PATIENTS WITH DISORDERS OF CONSCIOUSNESS
- Rita Formisano (Italy)
Abstract
Background and Aims:
Covert cognition may be present in around 15% of patients with Disorder of Consciousness (DoC). The lack of overt behavioural responsiveness may be due to many confounding factors, including diffuse pain. Aim of the present study was to compare, in non-communicative DoC patients, NCS-R scores obtained with the pressure on fingernail bed (standard stimulus, SS) versus other personalized painful stimuli (PS), shared with the rehabilitation staff and to verify possible correlations between NCS-R and Coma Recovery Scale-Revised (CRS-R).
Methods:
From a population of 66 patients (35 M and 31 F) enrolled in the study (mean age 42,74 years, range 14-69) diagnosed with DoC, according to the CRS-R, we selected a subgroup of 22 patients [10 M and 12 F; mean age =40,72 years (range 14-69); etiology: 10 TBI; 3 anoxia; 7 vascular (hemorrhagic or ischemic); 1 encephalitis], and assessed by means of NCS-R with PS (NCS-R-PS) versus SS (NCS-R-SS).
Results:
NCS-R-PS reached higher scores as compared to the NCS-R-SS, both for the total score and for motor and facial expression subscores (p<0.05). Significant correlation with CRS-R were found for both NCS-R-SS (r=0.613, p=0.0031) and NCS-R-PS (r=0.539, p=0.0117).
Conclusions:
Standard painful stimulation may be affected by sensory deficits of central and peripheral etiology and by the different pain sources. A personalized painful stimulation may be of some support to unveil covert cognition in non-communicative patients and to alleviate their possible sufferance by pain killers, improving responsiveness and quality of life.