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Brain Sci. 2016, 6(4), 47;

Disorders of Consciousness: Painless or Painful Conditions?—Evidence from Neuroimaging Studies

Neurological Institute, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila 67100, Italy
Psychology Division, School of Natural Sciences, University of Stirling, Scotland FK8, UK
Post-Coma Intensive Rehabilitation Care Unit, San Raffaele Hospital, Cassino 03043, Italy
Author to whom correspondence should be addressed.
Academic Editor: Patrick W. Stroman
Received: 15 June 2016 / Revised: 26 September 2016 / Accepted: 28 September 2016 / Published: 8 October 2016
(This article belongs to the Special Issue Functional Neuroimaging of Pain)
Full-Text   |   PDF [243 KB, uploaded 8 October 2016]


The experience of pain in disorders of consciousness is still debated. Neuroimaging studies, using functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET), multichannel electroencephalography (EEG) and laser-evoked potentials, suggest that the perception of pain increases with the level of consciousness. Brain activation in response to noxious stimuli has been observed in patients with unresponsive wakefulness syndrome (UWS), which is also referred to as a vegetative state (VS), as well as those in a minimally conscious state (MCS). However, all of these techniques suggest that pain-related brain activation patterns of patients in MCS more closely resemble those of healthy subjects. This is further supported by fMRI findings showing a much greater functional connectivity within the structures of the so-called pain matrix in MCS as compared to UWS/VS patients. Nonetheless, when interpreting the results, a distinction is necessary between autonomic responses to potentially harmful stimuli and conscious experience of the unpleasantness of pain. Even more so if we consider that the degree of residual functioning and cortical connectivity necessary for the somatosensory, affective and cognitive-evaluative components of pain processing are not yet clear. Although procedurally challenging, the particular value of the aforementioned techniques in the assessment of pain in disorders of consciousness has been clearly demonstrated. The study of pain-related brain activation and functioning can contribute to a better understanding of the networks underlying pain perception while addressing clinical and ethical questions concerning patient care. Further development of technology and methods should aim to increase the availability of neuroimaging, objective assessment of functional connectivity and analysis at the level of individual cases as well as group comparisons. This will enable neuroimaging to truly become a clinical tool to reliably investigate pain in severely brain-injured patients as well as an asset for research. View Full-Text
Keywords: consciousness; neuroimaging; pain; vegetative state; unresponsive wakefulness syndrome; minimally conscious state consciousness; neuroimaging; pain; vegetative state; unresponsive wakefulness syndrome; minimally conscious state
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Pistoia, F.; Sacco, S.; Stewart, J.; Sarà, M.; Carolei, A. Disorders of Consciousness: Painless or Painful Conditions?—Evidence from Neuroimaging Studies. Brain Sci. 2016, 6, 47.

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