Reproducibility of pain responses: A necessary condition for pain measurement in cognitive failure
Colloca, Luana, Department of Neuroscience, University of Turin, Turin, Italy, Pollo, Antonella, Department of Neuroscience, University of Turin, Turin, Italy

In order to assess the presence of pain in patients who can not communicate, it is necessary to find objective and reliable measures of pain. Although many behavioural scales have been developed for non-communicative patients, e.g. demented patients, little attention has been paid on physiological measurements, like autonomic responses. One of the main problems is represented by the reliability and repeatability of the autonomic response over time. In this study, we approached this problem by measuring subjective and objective responses to pain in order to see whether an individual trait of pain responsiveness could be identified. To do this, we studied 34 healthy volunteers who were tested three different times over three weeks for heart rate change following painful electric shock. By performing linear regression analysis for heart rate changes and Spearman correlation for subjective report of pain, we found high correlation coefficients across the three weeks for all the parameters we considered, that is, pain threshold, pain perception at pain thresholdX1.5, pain-induced heart rate increase, and anticipatory heart rate response. These findings show that heart rate responses to a phasic pain stimulus are constant and repeatable over time, thus suggesting that there is an individual trait for both pain perception and pain autonomic responses. Interestingly, this holds true for anticipatory heart rate response as well, thus suggesting an individual trait for anticipatory anxiety. A type of pain response that is characteristic for a single individual represents an important point for pain assessment in the non-communicative patient. For example, a response pattern can be assessed at the beginning of the cognitive decline, and then identified when the patient can no longer communicate.