Patients with unresponsive wakefulness syndrome respond to the pain cries of other people

Yu, Tao; Lang, Simone; Vogel, Dominik; Markl, Alexandra; Müller, Friedemann; Kotchoubey, Boris

doi:10.1212/wnl.0b013e31827f0846

Cited by 59 publications

(38 citation statements)

References 40 publications

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“…Furthermore, two other studies reported an activation of the affective pain network (i.e. ACC and insula) in 30% of patients in a VS/UWS in response to noxious stimulation as well as pain cries [27,28] (Figure 1). The last study, nevertheless, also showed, in parallel to previous findings, that the connectivity within the whole pain network was significantly decreased as compared to patients in a MCS [29].…”

Section: Pain Processing and Disorders Of Consciousnessmentioning

confidence: 90%

Pain issues in disorders of consciousness

Chatelle¹,

Thibaut²,

Whyte³

et al. 2014

Brain Injury

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Background: The assessment of pain and nociception in non-communicative patients with disorders of consciousness (DOC) is a real challenge for clinicians. It is, therefore, important to develop sensitive standardized tools usable at the bedside. Objectives: This review aims to provide an overview of the current knowledge about pain processing and assessment in patients with DOC. Methods: A search was performed on PubMed using MeSH terms including vegetative state, unresponsive wakefulness syndrome, minimally conscious state, consciousness disorders, pain, nociception, neuroimaging and pain assessment. Results: Neuroimaging studies investigating pain processing in patients with DOC and their implication for clinicians are reviewed. Current works on the development of standardized and sensitive tools for assessing nociception are described. Conclusion: The suggested pain perception capacity highlighted by neuroimaging studies in patients in a MCS and in some patients in a VS/UWS supports the idea that these patients need analgesic treatment and monitoring. The first tool which has been developed to assess nociception and pain in patients with DOC is the NCS. Its revised version represents a rapid, standardized and sensitive scale which can be easily implemented in a clinical setting. Complementary pain assessments are also under validation in order to offer more options to clinicians.

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Section: Pain Processing and Disorders Of Consciousnessmentioning

confidence: 90%

Pain issues in disorders of consciousness

Chatelle¹,

Thibaut²,

Whyte³

et al. 2014

Brain Injury

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show abstract

“…However, cognitive function detected by current technologies is still unable to reliably prove the consciousness of a DOC patient. Brain activity alone cannot prove patient consciousness, though it has been hypothesized that consciousness is associated with brain activity (27). Importantly, a fundamental distinction between consciousness and unconsciousness is yet to be determined.…”

Section: Reliability Of Novel Diagnostic Technologiesmentioning

confidence: 99%

Chronic disorders of consciousness

Xie

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Over the last 20 years, studies have provided greater insight into disorders of consciousness (DOC), also known as altered state of consciousness. Increased brain residual functions have been identified in patients with DOC due to the successful application of novel next-generation imaging technologies. Many unconscious patients have now been confirmed to retain considerable cognitive functions. It is hoped that greater insight regarding the psychological state of patients may be achieved through the use of functional magnetic resonance imaging and brain-computer interfaces. However, issues surrounding the research and treatment of DOC remain problematic. These include differing opinions on the definition of consciousness, difficulties in diagnosis, assessment, prognosis and/or treatment, and newly emerging ethical, legal and social issues. To overcome these, appropriate care must be offered to patients with DOC by clinicians and families, as DOC patients may now be considered to live in more than just a vegetative state. The present article reviews the controversy surrounding the definition of consciousness and the reliability of novel technologies, prognostic prediction, communication with DOC patients and treatment methods. The ethical and social issues surrounding the treatment of DOC and future perspectives are also considered.

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“…As a result, we must be careful not to rule out the possibility that a patient is sentient simply because she has not demonstrated awareness. For example, a study by Yu and colleagues found that 24 of 44 patients diagnosed as vegetative demonstrated significant neural activation in response to the pain cries of others, with four demonstrating activation virtually identical to those of healthy subjects (Yu et al 2013). These findings are consistent with the view that affective states (e.g., pain and pleasure) may be more basic elements of consciousness, as opposed to the more complex elements implied by cognitive awareness (e.g., attention, working memory, and language comprehension) (Panksepp 2005).…”

Section: Pain: a Multidimensional Experiencementioning

confidence: 99%

An Ethics of Welfare for Patients Diagnosed as Vegetative With Covert Awareness

et al. 2015

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Recent research suggests that a minority of patients diagnosed as vegetative using traditional behavioral assessments may be covertly aware. One of the most pressing concerns with respect to these patients is their welfare. This article examines foundational issues concerning the application of a theory of welfare to these patients, and develops a research agenda with patient welfare as a central focus. We argue that patients diagnosed as vegetative with covert awareness likely have sentient interests, and because sentient interests are sufficient for moral status, others have an obligation to take the welfare interests of these patients seriously. However, we do not view sentient interests as necessary for moral status, and thus it is possible that vegetative patients who lack such interests have moral status for other reasons. We propose four areas in which future research is needed to guide the ethical treatment of these patients: the assessment and management of pain; the development of quality of life assessments; end-of-life decision making; and enriching the day-to-day lives of these patients.

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Patients with unresponsive wakefulness syndrome respond to the pain cries of other people

Cited by 59 publications

References 40 publications

Pain issues in disorders of consciousness

Pain issues in disorders of consciousness

Chronic disorders of consciousness

An Ethics of Welfare for Patients Diagnosed as Vegetative With Covert Awareness

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