title: Evidence of altered pressure pain thresholds in persons with disorders of consciousness as measured by the Nociception Coma Scale-Italian version.
abstract: Pain assessment in patients with disorders of consciousness (DoC) is a controversial issue for clinicians, who require tools and standardised procedures for testing nociception in non-communicative patients. The aims of the present study were, first, to analyse the psychometric properties of the Italian version of the Nociception Coma Scale and, second, to evaluate pressure pain thresholds in a group of patients with DoC. The authors conducted a multi-centre study on 40 healthy participants and 60 DoC patients enrolled from six hospitals in Italy. For each group an electronic algometer was used to apply all nociceptive pressure stimuli. Our results show that the Italian version of the NCS retains the good psychometric properties of the original version and is therefore suitable for standardised pain assessment in clinical practice. In our study, pressure pain thresholds measured in a group of patients in vegetative and minimally conscious state were relatively lower than pain threshold values found in a group of healthy participants. Such findings motivate additional investigation on possible pain sensitisation in patients with severe brain injury and multiple co-morbidities, and on application of tailored therapeutic approaches useful for pain management in patients unable verbally to communicate their feelings.
authors.affiliation: a Neurology Public Health and Disability Unit - Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Davide
authors.identifier: http://orcid.org/0000-0001-7736-4337
authors.initials: D
authors.lastname: Sattin
authors.affiliation: b Department of Neurosurgery , University of California , Los Angeles , USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.affiliation: a Neurology Public Health and Disability Unit - Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.affiliation: c C. Golgi Geriatric Institute , ASP Golgi Redaelli , Milan , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Arenare
authors.affiliation: d Nucleo di Accoglienza per Persone in Stato Vegetativo , Don Carlo Gnocchi IRCCS Foundation, ONLUS , Milan , Italy.
authors.forename: Guya
authors.initials: G
authors.lastname: Devalle
authors.affiliation: e Medical Directorate , Don Carlo Gnocchi IRCCS Foundation, ONLUS , Milan , Italy.|f Geriatric Polifunctional Center S. Pietro of Monza , Monza , Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Giunco
authors.affiliation: g Don Orione Centre , Bergamo , Italy.
authors.forename: GianBattista
authors.initials: G
authors.lastname: Guizzetti
authors.affiliation: h Rehabilitation Unit - Villa Beretta , Valduce Hospital , Costa Masnaga , Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lanfranchi
authors.affiliation: a Neurology Public Health and Disability Unit - Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Ambra M
authors.identifier: http://orcid.org/0000-0002-7496-6727
authors.initials: AM
authors.lastname: Giovannetti
authors.affiliation: i Department of Psychology , e-Campus University , Novedrate , Italy.
authors.forename: Venusia
authors.initials: V
authors.lastname: Covelli
authors.affiliation: j Neurology Unit, UCV , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Bersano
authors.affiliation: k Neuroradiology Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Nigri
authors.affiliation: l Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Minati
authors.affiliation: m Neurophysiology and Diagnostic Epileptology Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi Sebastiano
authors.affiliation: j Neurology Unit, UCV , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Parati
authors.affiliation: k Neuroradiology Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: MariaGrazia
authors.initials: M
authors.lastname: Bruzzone
authors.affiliation: m Neurophysiology and Diagnostic Epileptology Unit , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Franceschetti
authors.affiliation: a Neurology Public Health and Disability Unit - Scientific Directorate , Neurological Institute C. Besta IRCCS Foundation , Milan , Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
mesh_terms: D000328:Adult; D003244:Consciousness Disorders / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059226:Nociceptive Pain / Q000175:diagnosis / Q000503:physiopathology; D015588:Observer Variation; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D011594:Psychometrics; D012680:Sensitivity and Specificity
keywords: Nociception test; disorders of consciousness; pain assessment; pressure pain thresholds; vegetative state