The problem of assessing pain in vegetative patients

As a neuroscientist and neuroethicist who studies the nature of pain, I was fascinated by the recent report that advanced neuroimaging has demonstrated cognitive activity in a vegetative patient ["Beneath the 'vegetative state,' scientists find some alert minds," front page, Feb. 4]. But I was disappointed that only a passing reference was made to the related question of pain care in such patients. The implications are especially troubling when it comes to invasive procedures such as surgery.

Anesthesia has been commonly used in almost every invasive medical procedure for many decades, yet is often overlooked when the patient is severely neurologically compromised, because of a longstanding belief that the compromised brain is not sensitive to pain. But there is growing doubt about this, in part because of mounting evidence that neural pathways for pain may involve brain structures that can remain relatively intact after trauma. Findings such as those reported in The Post add to this doubt.

As a result, we have an urgent moral responsibility to take a much closer look at pain care in neurologically compromised patients. This may include precautionary treatment of those whose experience of pain is impossible to assess, and families of those patients should insist that health-care providers err on the side of comfort.

James Giordano, Arlington

The writer is director of the Center for Neurotechnology Studies at the Potomac Institute for Policy Studies.