Nociception Coma Scale with personalized painful stimulation versus standard stimulus in non-communicative patients with disorders of consciousness

R. Formisano, M. Contrada, M. Aloisi, G. Ferri, S. Schiattone, M. Iosa, M. G. Buzzi

Research output: Contribution to journalArticle


Introduction: Persons with disorders of consciousness (DoC) may perceive pain without being able to communicate their discomfort. Nociception Coma Scale (NCS) and its revised form (NCS-R) have been proposed to assess nociception in coma survivors with DoC. Objective: Aim of the present study was to compare, in non-communicative patients with DoC, NCS-R scores obtained with the standard pressure on fingernail bed (standard stimulus, SS) versus other personalized painful stimuli (PS), to verify possible correlations between NCS-R and Coma Recovery Scale-Revised (CRS-R). Materials and Methods: Twenty-one patients with DoC were included in the study. Responsiveness and pain perception were assessed by CRS-R and NCS-R with standard stimulus (NCS-R-SS) and personalized stimulation (NCS-R-PS). Statistical analysis was performed with the nonparametric Wilcoxon test for comparison of both total NCS-R-SS and NCS-R-PS scores. Results: NCS-R at admission showed that 9 of 21 patients (42.8%) had higher scores in response to personalized stimulus compared to standard stimulus. Significant correlation with CRS-R were found for both NCS-R-SS (R = 0.701, p =.008) and NCS-R-PS (R = 0.564, p =.045). Discussion: The preliminary results obtained in the present study suggest that NCS-R-PS may disclose pain perception in a larger number of non-communicative patients with DoC, compared to NCS-R-SS.

Original languageEnglish
JournalNeuropsychological Rehabilitation
Publication statusPublished - Jan 1 2019



  • Coma Recovery Scale-Revised
  • Disorder of consciousness
  • Nociception Coma Scale-revised
  • Non-communicative patients
  • Pain
  • Responsiveness

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Rehabilitation
  • Arts and Humanities (miscellaneous)
  • Applied Psychology

Cite this