Longitudinal assessment of somatosensory and pain circuitry in DOC patients and its possible role in measuring patients' outcome: a pilot study.
We aim to investigate the role of pain perception in consciousness recovery in non-communicative severe brain injury (SBI) patients, during acute and subacute stage after the SBI. Acutely, SBI patients' brains suffer neuroplastic remodeling of key structures that, in favorable cases, support consciousness. Pain can largely alter brain plasticity, especially in chronic painful conditions, as the ones that may follow SBI at all stages (e.g. pain following the trauma itself, muscle pain due to spasticity, etc). We speculate that alterations of pain circuitry may concur to poor recovery of consciousness. Using a personalized source of thermal painful stimulation, in order to avoid useless and harmful stimuli, we will study pain responses in acute SBI patients by using neurophysiological and a task-related and resting state fMRI-based neural signature of pain (consistently developed in healthy subjects). We will support neuroimaging and neurophysiological data with clinical evaluation of pain (Nociception Coma Scale revised) and consciousness (Four Score and Coma Recovery Scale). We expect that differences in brain responses to pain among patients will predict good outcome and suggest possible therapeutic targets.