title: Pain issues in disorders of consciousness.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Coma Science Group, Cyclotron Research Centre, University of Liège , Liège , Belgium .
authors.forename: Camille
authors.initials: C
authors.lastname: Chatelle
authors.forename: Aurore
authors.initials: A
authors.lastname: Thibaut
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Marie Danièle
authors.initials: MD
authors.lastname: De Val
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
mesh_terms: D003244:Consciousness Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D059907:Functional Neuroimaging; D006801:Humans; D059225:Nociception; D010146:Pain / Q000175:diagnosis* / Q000523:psychology; D059408:Pain Management; D010147:Pain Measurement; D058748:Pain Perception; D011379:Prognosis; D012680:Sensitivity and Specificity
keywords: Minimally conscious state; nociception; pain assessment; unresponsive wakefulness syndrome; vegetative state