altered perceptions? minimally conscious patients may have a greater capacity to feel pain than do those in a vegetative state (as Terri Schiavo, above).
Reuters
Most of the time, doctors have a simple way to determine whether a patient needs medication against pain: They ask. But when a brain injury makes someone unable to answer questions, the right of action becomes murkier. Now a study finds that the brains of some brain-damaged patients respond to a rude shock as much as the brains of healthy people, suggesting that these patients may experience pain, even if they are unable to show.
little is known about the perception of pain in unconscious patients, says Steven Laureys, a neurologist at the University of Liège in Belgium and lead author of the new study. Therefore, we must provide medication is each doctor. Some doctors hold drugs, Laureys said, assuming that these patients are unable to feel pain. Other doctors give more liberal drugs but may turn sedating patients and missing signs of wavering consciousness.
In the new study, Laureys and colleagues used positron emission tomography (PET) to measure activity in the brains of 15 healthy volunteers; 15 patients in a "vegetative state", a famous illustrated provided by Terri Schiavo, who showed signs of awakening, but did not meet the current and its environment; and five patients in a little better condition known as a "minimally conscious state," characterized by responsiveness and limited and sporadic awareness. While few conscious patients can sometimes turn to someone calling their name, for example, vegetative patients may not respond.
In healthy subjects, a zap wrist elicits activity in the brain regions that rev in response to pain, including the thalamus, insula, somatosensory cortex and the anterior cingulate cortex. In patients who were in a vegetative state, activity in these regions has been reduced, and the time of cooking in different regions was abnormal. But little conscious patients had levels and timing of brain activity that were very similar to those of healthy people, the researchers report online this week in The Lancet Neurology . Although PET and other neuroimaging tools never reveal what people feel in fact, Laureys said the new results suggest that little conscious patients may have a greater ability to register pain compared to those in a vegetative state - and a greater need medication to treat it. The ability to feel pain can be another factor for the families of patients to consider when weighing decisions of end of life, he added.
The results are an important contribution to a little studied area, said Nicholas Schiff, a neurologist at the Hospital of New York-Presbyterian / Weill Cornell Medical College in New York. Minimally conscious patients can not speak or even wince to let the doctors know they are in pain, Schiff notes: "There is nothing to guide you without this kind of data." Although Schiff said, researchers need to study a larger sample of patients before taking specific guidelines for drug against pain.
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