, Volume 6, Issue 1, pp 37–50 | Cite as

Pain Perception in Disorders of Consciousness: Neuroscience, Clinical Care, and Ethics in Dialogue

  • A. Demertzi
  • E. Racine
  • M-A. Bruno
  • D. Ledoux
  • O. Gosseries
  • A. Vanhaudenhuyse
  • M. Thonnard
  • A. Soddu
  • G. Moonen
  • S. Laureys
Original Paper


Pain, suffering and positive emotions in patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious states (MCS) pose clinical and ethical challenges. Clinically, we evaluate behavioural responses after painful stimulation and also emotionally-contingent behaviours (e.g., smiling). Using stimuli with emotional valence, neuroimaging and electrophysiology technologies can detect subclinical remnants of preserved capacities for pain which might influence decisions about treatment limitation. To date, no data exist as to how healthcare providers think about end-of-life options (e.g., withdrawal of artificial nutrition and hydration) in the presence or absence of pain in non-communicative patients. Here, we aimed to better clarify this issue by re-analyzing previously published data on pain perception (Prog Brain Res 2009 177, 329–38) and end-of-life decisions (J Neurol 2010 258, 1058–65) in patients with disorders of consciousness. In a sample of 2259 European healthcare professionals we found that, for VS/UWS more respondents agreed with treatment withdrawal when they considered that VS/UWS patients did not feel pain (77%) as compared to those who thought VS/UWS did feel pain (59%). This interaction was influenced by religiosity and professional background. For MCS, end-of-life attitudes were not influenced by opinions on pain perception. Within a contemporary ethical context we discuss (1) the evolving scientific understandings of pain perception and their relationship to existing clinical and ethical guidelines; (2) the discrepancies of attitudes within (and between) healthcare providers and their consequences for treatment approaches, and (3) the implicit but complex relationship between pain perception and attitudes toward life-sustaining treatments.


Pain End-of-life Vegetative state Minimally conscious state Ethics Attitudes Survey 



This research was funded by the Belgian National Funds for Scientific Research (FNRS), the European Commission, the James McDonnell Foundation, the Mind Science Foundation, the French Speaking Community Concerted Research Action (ARC-06/11-340), the Public Utility Foundation “Université Européenne du Travail”, “Fondazione Europea di Ricerca Biomedica” and the University and University Hospital of Liège. Writing of this paper was also supported by the Canadian Institutes of Health Research (New Investigator Award and Operating grant). We would also like to thank Dr. Emily Bell for helpful feedback on a previous version of this manuscript.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • A. Demertzi
    • 1
    • 2
  • E. Racine
    • 3
    • 4
    • 5
  • M-A. Bruno
    • 1
    • 2
  • D. Ledoux
    • 1
    • 6
  • O. Gosseries
    • 1
    • 2
  • A. Vanhaudenhuyse
    • 1
    • 2
  • M. Thonnard
    • 1
    • 2
  • A. Soddu
    • 1
    • 2
  • G. Moonen
    • 2
    • 7
  • S. Laureys
    • 1
    • 2
  1. 1.Coma Science Group, Cyclotron Research CenterUniversity of LiègeLiègeBelgium
  2. 2.CHU Neurology DepartmentUniversity Hospital of LiègeLiègeBelgium
  3. 3.Neuroethics Research UnitInstitut de recherches cliniques de MontréalMontrealCanada
  4. 4.Department of Medicine and Department of Social and Preventive MedicineUniversité de MontréalMontrealCanada
  5. 5.Departments of Neurology and Neurosurgery, Medicine & Biomedical Ethics UnitMcGill UniversityMontrealCanada
  6. 6.CHU Department of Intensive CareUniversity of LiègeLiègeBelgium
  7. 7.University of LiègeLiègeBelgium

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