Where in the brain is pain? Evaluating painful experiences in non-communicative patients

Athena Demertzi and Steven Laureys

in I Know What You're Thinking

Published in print August 2012 | ISBN: 9780199596492
Published online September 2012 | e-ISBN: 9780191745669 | DOI:
Where in the brain is pain? Evaluating painful experiences in non-communicative patients

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Pain is a personal and intimate experience. As with other conscious experiences, pain needs to be communicated in order to be assigned to a subject. In cases of severely brain-injured non-communicative patients, conscious perception of pain needs to be inferred from motor responses to noxious stimulation. Neuroimaging technologies (positron emission tomography, functional magnetic resonance imaging) and electroencephalography/ event-related potentials can now help to illuminate this clinical difficulty. The aim of the present chapter is to describe residual pain perception in non-communicative patients as evaluated via behavioural and neuroimaging protocols. The necessity of standardized, sensitive and specific behavioural tools, such as the recently introduced Nociception Coma Scale, is highlighted. Activation and resting state neuroimaging studies provide alternative information about residual pain perception and in some cases may influence clinical diagnosis. Lastly, it is acknowledged that pain is principally a private experience; although it remains impossible to know in any meaningful sense how much pain a patient may suffer, its clinical and ethical significance in coma-emergent patients should be appraised in order for efficient pain management guidelines to be developed.

Keywords: pain; fMRI; nociception; PET; Nociception Coma Scale; pain management

Chapter.  4456 words.  Illustrated.

Subjects: Neuroscience

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