I Feel! Therefore, I Am from Pain to Consciousness in DOC Patients

Abstract

Pain assessment and management in patients with disorders of consciousness (DOC) is a challenging and important aspect of care, with implications for detecting consciousness and promoting recovery. This narrative review explores the role of pain in consciousness, the challenges of pain assessment, pharmacological treatment in DOC, and the implications of pain assessment when detecting changes in consciousness. The review discusses the Nociception Coma Scale and its revised version, which are behavioral scales used to assess pain in DOC patients, and the challenges and controversies surrounding the appropriate pharmacological treatment of pain in these patients. Moreover, we highlight recent evidence suggesting that an accurate pain assessment may predict changes in the level of consciousness in unresponsive wakefulness syndrome/vegetative state patients, underscoring the importance of ongoing pain management in these patients.

Basic, Translational, and Clinical Research on Dementia

“…In DOC patients, difficulties in accurately predicting an individual's ability to experience pain and distress are very difficult [22]. An accurate assessment of pain responses can provide insights into changes in the individual's level of consciousness, further emphasizing the ongoing importance of managing pain in these patients, as highlighted by Riganello et al [23].…”