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Is the Nociception Coma Scale-Revised a Useful Clinical Tool for Managing Pain in Patients With Disorders of Consciousness?

Chatelle, Camille PhD; De Val, Marie-Daniele RN, Msc; Catano, Antonio MD, PhD; Chaskis, Cristo MD; Seeldrayers, Pierrette MD, PhD; Laureys, Steven MD, PhD; Biston, Patrick MD; Schnakers, Caroline PhD

doi: 10.1097/AJP.0000000000000259
Original Articles

Objectives: Our objective was to assess the clinical usefulness of the Nociception Coma Scale-revised (NCS-R) in pain management of patients with disorders of consciousness.

Materials and Methods: Thirty-nine patients with potential painful conditions (eg, due to fractures, decubitus ulcers, or spasticity) were assessed during nursing cares before and after the administration of an analgesic treatment tailored to each patient’s clinical status. In addition to the NCS-R, the Glasgow Coma Scale (GCS) was used before and during treatment to observe fluctuations in consciousness. Twenty-three of them had no analgesic treatment before the assessment, whereas the analgesic treatment has been adapted in the other 16 patients. We performed nonparametric Wilcoxon tests to investigate the difference in the NCS-R and GCS total scores but also in the NCS-R subscores before versus during treatment. The effect of the level of consciousness and the etiology were assessed using a Mann-Whitney U test.

Results: NCS-R total scores were statistically lower during treatment when compared with the scores obtained before treatment. We also found that the motor, verbal, and facial expression subscores were lower during treatment than before treatment. In contrast, we found no difference between the GCS total scores obtained before versus during treatment.

Discussion: Our results suggest that the NCS-R is an interesting clinical tool for pain management. Besides, this tool seems useful when a balance is needed between reduced pain and preserved level of consciousness in patients with disorders of consciousness.

*Coma Science Group, Cyclotron Research Centre, University of Liège, Liège

Acute Pain Service

Departments of §Intensive Care



**Neurology, University Hospital of Charleroi, Charleroi, Belgium

Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School

Department of Neurology, Massachusetts General Hospital, Boston, MA

††Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA

C.C. and M.D.V. contributed equally.

Supported by the National Funds for Scientific Research (FNRS), James S. McDonnell Foundation, Mind Science Foundation, University of Liège, Liege, the Belgian American Educational Foundation (BAEF), the Fédération Wallonie Bruxelles International (WBI), and the Belgian interuniversity attraction pole, the Dana Foundation, and the Massachusetts General Hospital Department of Neurology and Division of Neurocritical Care and Emergency Neurology, Boston. The authors declare no conflict of interest.

Reprints: Caroline Schnakers, PhD, Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA 90095-1563 (e-mail:

Received February 4, 2015

Received in revised form July 17, 2015

Accepted May 21, 2015

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