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Patients who recover from coma but cannot communicate feel pain

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07.10.2008

Do patients who survive a severe brain injury but fail to recover speech or non-verbal communication perceive pain ? After their remarkable publication where they showed that a patient in a vegetative state in reality was conscious*, scientists at the University of Liège (ULg) were able to tackle the very difficult issue of pain perception in coma survivors.

The Coma Science Group of the Cyclotron Research Centre and Neurology Department of the ULg used PET scanning to measure minimally conscious and vegetative patients’ brain activation in response to noxious stimulation.

After comparing results obtained in the different patient groups with those in healthy volunteers who could communicate it felt painful they concluded that minimally conscious patients must feel pain despite being unable to tell their environment. Hence, these patients should receive pain-killers, the authors concluded.

This study has major ethical and therapeutical consequences also with regard to end-of-life decisions in these challenging but vulnerable patient populations.

The study was led by Pr Steven Laureys from the Coma Science Group of the University of Liège and will be published this week in the prestigious journal Lancet Neurology.

* “Detecting Awareness in the Vegetative State”, Science, 08/09/2006, vol.313, p. 1402.

“Perception of pain in the minimally conscious state with PET activation : an observational study”. The Lancet Neurology, publication online 06/10/2008, www.thelancet.com/neurology (doi : 10.1016/S1474-4422(08)70220-5)

Authors: Mélanie Boly, Marie-Elisabeth Faymonville, Caroline Schankers, Philippe Peigneux, Bernard Lambermont, Christophe Philipps, Patrizio Lancellotti, André Luxen, Maurice Lamy, Gustave Moonen, Pierre Maquet, Steven Laureys.

Didier Moreau | Source: alphagalileo
Further information: www.ulg.ac.be
www.thelancet.com/neurology

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