The perception of pain and its management in disorders of consciousness

"One of the most controversial issues in the management. of patients in a vegetative state or a minimally. conscious state concerns their hypothetical capacity to continue. to experience pain despite an apparent absence of self- and. environmental awareness. Recent functional neuroimaging. studies have shown a greater perception of pain in patients. in minimally conscious state compared with patients in vegetative. state, suggesting the possible involvement of preserved. cognitive mechanisms in the process of pain modulation in the. former. In addition, a subgroup of patients might continue to. experience some elementary emotional and affective feelings,. as suggested by the reported activation of specific cerebral. areas in response to situations, which commonly generate. empathy. However, the available evidence is not sufficient to. draw conclusions about the presence or absence of pain experience. in patients with disorders of consciousness. Future. studies should contribute to a better understanding of which. central neural pathways are involved in the perception and. modulation of pain in healthy subjects and in patients with. severe brain injuries. Such studies should thus also improve. our know-how about pain management in this particularly. challenging group of patients."