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On the other hand, muscle twitches usually do not cause pain

They're manageable

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(PubMed) Rohan TE, Jain MG, Howe GR, Miller AB

Quality of evidence: II-B, Strength of recommendation: 1 Panel level of agreement: In total agreement 87%, in partial agreement 13% Patients with ALF, HE, and at risk for an increase in ICP should be managed in a calm environment, with serum sodium monitoring (maintaining levels between 140 and 145 mmol/l) and HE treatment with lactulose and rifaximin