1 Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
2 Hospital Municipal Professor Doutor Alípio Corrêa Netto – Ermelino Matarazzo.
3 Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
4 Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.
5 Complexo Hospitalar de Clínicas Márcia Braido de São Caetano.
Silvia Monica Cárdenas Prado ORCID: 000 0003 0263 8799
Manoel Jacobsen Teixeira; ORCID: 0000-0002-7974- 6045
Julio Cesar Acosta-Navarro; ORCID: 0000-0002-4416-9372
Hannah Alves Barreto; ORCID: 0009-0007-8254-9070
Clara Lorena Ferreira Andrade; ORCID: 0009-0004-4245-477X
Maria Isabel Magela Cangussu; ORCID: 0009-0000-3471-6486
Jefferson Rosi Junior; ORCID: 0009-0000-5695-5461
Walter Nelson Cartagena Miranda; ORCID: 0009-0007-9440-6157
Antônio Almeida Chagas Filho; ORCID: 0009 0008 5274 7225
Pedro Voltron Acosta-Cárdenas; ORCID: 0000 0002 0316 3206
Bianca Pimpão Teixeira; ORCID: 0000 0001 9224 8932
Frank Hugo Cárdenas Acosta; ORCID: 0009-0005-0819-5759
Ana Godinho Resende; ORCID: 0009-0000-7150-1716
GSC Advanced Research and Reviews, 2026, 28(01), 252–263
Article DOI: 10.30574/gscarr.2026.28.1.0159
Received on 23 May 2026; revised on 07 July 2026; accepted on 09 July 2026
Background: One of the greatest challenges in understanding pain is the difficulty in assessing or recognizing it in patients with disorders of consciousness (DOC).
Objective: To compare the nociception using the Nociception Coma Scale Revised (NCS-R) in DOC. Methods: In the first phase, patients with DOC were evaluated using the Coma Recovery Scale-Revised (CRS-R) to diagnose the type of DOC, either Unresponsive Wakefulness Syndrome (UWS) or Minimally Conscious State (MCS). Subsequently, the Modified Glasgow Coma Scale-Pupils Score (GCS-P) was applied, and the occurrence of pain was assessed using the NCS-R.
Main Outcome Measures: Score of NCS-R from UWS and MCS patients and correlations among CRS-R, GCS-P and NCS-R. In the second phase, a subgroup of patients with a cutoff score of ≥5 on the NCS-R was selected to evaluate the analgesic effect.
Results: The mean NCS-R scores were higher in the MCS group (n=42) compared to the UWS group, (n=14) with differences mainly attributed to the motor, verbal and facial components. Strong positive correlations were observed for the whole sample between NCS-R and GCS-P (r=0.788; p<0.001); between CRS-R and GCS-P (r=0.754; p<0.001) and between NCS-R and CRS-R (r=0.796; p<0.001). In the UWS group, a moderate positive correlation was also observed. In phase 2, in the NCS-R assessment, the two groups showed similar mean score.
Conclusions: We found that the UWS group had lower NCS-R scores than the MCS. In addition, across the entire sample and in the UWS group, the three scales used (CRS-R, GCS-P and NCS-R) showed positive correlations.
Consciousness Disorders; Pain Management; Nociception Coma Scale-Revised; Minimally Conscious State; Unresponsive Wakefulness Syndrome/Vegetative State.
Preview Article PDF
Silvia Monica Cárdenas Prado, Manoel Jacobsen Teixeira, Julio Cesar Acosta-Navarro, Hannah Alves Barreto, Clara Lorena Ferreira Andrade, Maria Isabel Magela Cangussu, Jefferson Rosi Junior, Walter Nelson Cartagena Miranda, Antônio Almeida Chagas Filho, Pedro Voltron Acosta-Cárdenas, Bianca Pimpão Teixeira, Frank Hugo Cárdenas Acosta and Ana Godinho Resende. Higher nociception scores in minimally conscious state compared to unresponsive wakefulness syndrome and positive correlations among CRS-R, GCS-P and NCS-R in Patients with Disorders of Consciousness. GSC Advanced Research and Reviews, 2026, 28(01), 252–263. Article DOI: https://doi.org/10.30574/gscarr.2026.28.1.0159.