Neuro ICU - "how to test for pain response in comatose individuals

Dear Gwenith

I am really grateful for your reply which shows your years of experience and expertise. I will bring these suggestions forward.

One of the disturbing things is of course that the nurses who do this are being taught this at learning institutions and through the example of the neurosugeons on ward rounds.
I feel so distressed when as a potentially abusive attempt to elicit a response so often there is no recognition of the time delay for any response and the whole group moves on as the poor patient then flickers an eyelid or the breathing changes or there is another sign which isnt even seen.

A young student asked about the time delay and was told,
Well if you dont move smartly when your nipple gets twisted that proves there's very little there" ....yike!

Thanks again and i really appreciate the wisdom and humanity I have witnessed on this string
jw

I've never even heard of using nipple squeezes to stimulate a reaction from unconscious patients! It sounds absolutely brutal. In the ICU where I just completed my prac, they use sternal pressure and nail pressure, in combination with loud verbal stimulation (just calling their name loudly). Oooh, just the thought of a 'nipple cripple' makes me cringe!

The nursing staff in our unit test for response to pain in the Glasgow coma scale through nipple squeezing.
I want to challenge this practice and would like advice on how this is approached in other hospitals.
JW