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Title: Patients in Minimally Conscious State Feel Pain, May Need Painkilling Treatment
URL: http://www.pslgroup.com/dg/22E546.htm
Doctor's Guide
October 7, 2008

NEW YORK -- October 7, 2008 -- A study of brain activity in brain-damaged patients in a minimally conscious state (MCS) suggests that they could have similar pain perception to healthy people and could need painkilling treatment, according to a study published early online and in the November issue of The Lancet Neurology.

Steven Laureys, MD, Coma Science Group, Cyclotron Research Center and Department of Neurology, University of Liège, Liège, Belgium, and colleagues compared brain activity following electrical stimulation of the median nerve in 5 MCS patients (aged 18-74 y) with 15 controls (19-64 y) and 15 patients in persistent vegetative state (PVS) (18-75 y).

They looked at the cortical pain matrix for pain sensation including the thalamus, the primary somatosensory cortex and the insular, frontoparietal, and anterior cingulate cortices.

The researchers found that none of these areas of the brain was less activated in MCS patients than in controls, and in MCS patients the cortical pain matrix was significantly more active than in PVS patients. MCS patients also showed better "connectivity" between different brain regions responsible for pain than did PVS patients.

"These findings might be objective evidence of a potential pain perception capacity in patients in MCS, which supports the idea that these patients need painkilling treatment," the authors wrote.

In an accompanying comment, John Whyte, MD, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, said: "Increased understanding of the neural processing that can take place in the absence of the conscious awareness, and the patterns of neural activity that are associated with volitional action and conscious experience, will undoubtedly shed light on the mechanistic differences among the highly heterogeneous, but functionally restricted, population of patients with disorders of consciousness."

SOURCE: The Lancet Neurology

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