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The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.
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http://dx.doi.org/10.3389/fnsys.2023.1112206 | DOI Listing |
Ann Afr Med
September 2025
Department of Anaesthesiology, Kasturba Medical College Mangalore Manipal Academy of Higher Education, Manipal, India.
Background: Regional anesthesia techniques, such as unilateral spinal anesthesia and peripheral nerve blocks, are essential components of multimodal analgesia. Nonetheless, "rebound pain," an abrupt increase in nociceptive intensity following the cessation of the block, is inadequately defined and may compromise patient satisfaction and functional recovery.
Aims And Objectives: This study aimed to compare postoperative pain profiles, the incidence of rebound pain, and patient satisfaction following popliteal sciatic nerve block versus unilateral spinal anesthesia in elective foot surgeries.
J Clin Monit Comput
September 2025
Pediatric Intensive Care Unit, CHU Lille, 59000, Lille, France.
The Analgesia Nociception Index (ANI) has been used to assess discomfort in anesthetized adults. The COMFORT Behavior Scale (CBS) is recommended for assessing discomfort in intubated and sedated children. The primary objective of the present study was to assess the validity and performance of the ANI as an indicator of discomfort in intubated, ventilated children in a pediatric intensive care unit (PICU).
View Article and Find Full Text PDFPain
August 2025
Centre for Multimodal Sensorimotor and Pain Research, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada.
The thermal grill, in which innocuous warm and cool stimuli are interlaced, can produce a paradoxical burning pain sensation-the thermal grill illusion (TGI). Although the mechanisms underlying TGI remain unclear, prominent theories point to spinal dorsal horn integration of innocuous thermal inputs to elicit pain. It remains unknown whether the TGI activates peripheral nociceptors, or solely thermosensitive afferents that are integrated within the spinal cord to give rise to a painful experience.
View Article and Find Full Text PDFSemin Vasc Surg
September 2025
Division of Vascular and Endovascular Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Comprehensive Wound Care Healing and Hyperbaric, Department of Surgery, Northwell Health System, 270-05 76(th) Avenue, New Hyde Park, NY 11040. Electronic address:
Nonhealing wounds are increasingly prevalent, present in 1% to 2% of the global population, with higher incidence in geriatric patients. These chronic wounds pose challenges to older adult patients owing to physiologic changes that hinder healing, common medical comorbidities that promote inflammation and damage microcirculation, poor nutritional status and mobility, and psychosocial barriers to receiving care. In this literature review, the epidemiology, pathophysiology, systems costs, and management of chronic venous leg ulcers, arterial ulcers, and diabetic foot wounds in older adult patients are investigated.
View Article and Find Full Text PDFFront Pain Res (Lausanne)
August 2025
UR4391 (ENT Team), Faculty of Health, Paris Est Créteil University, Créteil, France.