Autism and Pain: Study Finds Heightened Pain Sensitivity

Author: Wolters Kluwer Health
Published: 30 Nov 2022 - Updated: 1 Oct 2026
Publication Details: Peer-Reviewed | Findings

Table of Contents:
Synopsis - Definition - Overview - FAQs - Insights, Updates - Related Content

Synopsis

This research, published in the peer-reviewed journal PAIN from the International Association for the Study of Pain, tests the long-held clinical assumption that autistic people are indifferent or under-reactive to pain, and finds the opposite. Researchers at the University of Haifa ran detailed laboratory pain tests on 104 adults, half of them autistic, which made it the largest psychophysical pain study in autism at the time of publication. Autistic participants detected heat and pain at the same thresholds as everyone else, but once a stimulus became painful they consistently rated it as more intense, and their bodies were less able to dampen pain that lasted. This matters for autistic children and adults, their families, and the clinicians who treat them, because current diagnostic language still describes an apparent indifference to pain. That framing can lead to missed diagnoses and undertreated pain, especially in people who have difficulty describing what they feel. The findings come from controlled sensory testing rather than observation alone, which gives caregivers and medical staff solid grounds to take pain signals from autistic people seriously.*

At a Glance

• 1 - The study was funded by the Israel Science Foundation.
• 2 - Autistic participants reported higher anxiety and greater sensitivity to everyday smells, noise and light.
• 3 - Autistic participants could suppress short bursts of pain but not prolonged pain. Ongoing pain in daily life is a known risk factor for chronic pain.
• 4 - The researchers describe a pro-nociceptive pain profile, where the brain amplifies pain more and inhibits it less. This fits the excitatory and inhibitory imbalance theory of autism, which had rarely been applied to pain.

Topic Definition

Pain Hypersensitivity in Autism

Pain hypersensitivity in autism describes a pattern in which autistic people notice painful stimuli at typical thresholds but experience them as more intense than non-autistic people do, and have more difficulty suppressing pain that persists over time. Researchers call this a pro-nociceptive profile, meaning the nervous system leans toward amplifying pain signals rather than dampening them. It differs from the older belief that autistic people are pain-insensitive, which came mostly from observing outward behavior. In reality, differences in communication, facial expression and sensory processing can hide distress that is still there and may be quite strong.

Overview

Autistics Not Indifferent Nor Hypo-sensitive to Pain

"Indifference or Hypersensitivity? Solving the Riddle of the Pain Profile in Individuals With Autism" - PAIN.

People with autism have normal pain thresholds but increased sensitivity to painful stimuli, concludes a study in PAIN, the official publication of the International Association for the Study of Pain (IASP). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"This evidence demonstrating enhanced pain sensitivity warrants changing the common belief that autistic individuals experience less pain," according to the report by Prof. Irit Weissman-Fogel of University of Haifa, Israel, and colleagues. They believe their findings highlight the need for increased awareness, which may impact effective treatment of pain in people with autism.

New Evidence Questions Assumptions About Pain in Autism

The researchers aimed to test the "prevailing assumption" that people with autism are hypo-sensitive to pain. Current diagnostic criteria suggest that autistic people demonstrate "apparent indifference" to pain or temperature. Yet most previous studies have not shown differences in pain sensitivity in autistic individuals.

Prof. Weissman-Fogel and colleagues performed in-depth laboratory tests of pain perception in 104 adults, 52 with autism. This sample is the largest as of yet testing pain psychophysics in autism. The two groups had similar scores on a brief cognitive test. People with autism had higher use of psychiatric medications, and rated themselves as having greater anxiety as well as higher sensitivity to pain and to daily environmental stimuli (such as smell, noise, light). This research project was funded by the Israel Science Foundation (ISF; 1005/17).

On quantitative sensory tests, there were no differences in thermal and pain detection thresholds between the autistic and non-autistic groups. This indicates normal pain and thermal thresholds, suggesting "normal functioning of the peripheral nervous system" among participants with autism.

However, the autistic group gave consistently higher pain ratings in response to various stimuli above their pain threshold, proving pain hypersensitivity. The tests also provided evidence that people with autism can successfully inhibit short pain stimuli but not long-lasting pain stimuli. Importantly, experiencing long-lasting pain in daily life is a risk factor for developing chronic pain.

Findings May Lead to Early Treatment and Better Quality of Life

Together, the findings suggest that people with autism have a "pro-nociceptive" pain modulation profile: their brain appears more active in facilitating pain experience and less active in inhibiting continuous pain. This is consistent with the theory of excitatory/inhibitory imbalance as an underlying mechanism of autism spectrum disorder - but one that has been neglected in terms of pain processing.

The study questions the perception that people with autism experience less pain, and instead suggests that they may have enhanced pain sensitivity. Prof. Weissman-Fogel and colleagues write:

"This misinterpretation can lead to late diagnosis and poor treatment causing suffering and exacerbating the autistic symptoms" - potentially increasing the risk of developing chronic pain conditions. While their study focused on a group of autistic people with essentially normal cognitive function, the researchers write, "these results may also apply to people with autism whose cognitive and verbal communication impairments may eliminate their ability to communicate their pain."

Prof. Weissman-Fogel and coauthors conclude:

"These findings may raise physician, parent, and caregiver awareness to the pain phenomenon in autism, and thus lead to early and effective treatment to improve the wellbeing and quality of life for autistic individuals and their families."

Frequently Asked Questions

NOTE: Researched FAQs by Disabled World (DW)

How can caregivers recognize pain in an autistic person who does not speak?

Look for changes from the person's usual baseline, such as new self-injury, sleep disruption, refusing food, guarding a body part, increased stimming, aggression, or withdrawal. Keeping a simple log of these changes helps clinicians spot patterns that point to an underlying source of pain.

Are there pain assessment tools designed for people with communication disabilities?

Yes. Observational scales such as the Non-communicating Children's Pain Checklist and the FLACC scale rate behaviors like facial expression, movement, and vocal sounds. Visual pain scales using faces, colors, or numbers can also help autistic people who understand symbols but find spoken description difficult.

Why might an autistic person appear calm while in significant pain?

Differences in facial expression, body language, and interoception can mean outward signals do not match inner experience. Some autistic people also mask discomfort or have trouble identifying and naming bodily sensations, so a lack of visible reaction should never be taken as proof of no pain.

Is chronic pain more common in autistic adults?

Growing research suggests autistic adults report chronic pain conditions such as headaches, gastrointestinal pain, and joint pain at higher rates than the general population. Reduced ability to inhibit long-lasting pain may be one factor that raises this risk.

Can sensory overload make pain feel worse for autistic people?

Yes. Bright lights, loud sounds, strong smells, and crowded spaces can add to overall stress and heighten pain perception. Reducing sensory input during medical procedures, such as dimming lights or using noise-reducing headphones, can make care more tolerable.

How can medical appointments be adapted for autistic patients in pain?

Helpful steps include longer appointment times, a quiet waiting area, explaining each step before touching the patient, using visual schedules, and allowing a trusted support person to attend. Asking the patient or caregiver how pain is usually expressed also improves accuracy.

Does pain sensitivity differ between autistic children and autistic adults?

Most laboratory pain studies have focused on adults, so less is known about children. Researchers believe sensory processing differences are present from early development, which makes careful pain assessment important across all ages.

What role does anxiety play in how autistic people experience pain?

Anxiety is common in autism and can increase muscle tension, heighten attention to bodily sensations, and lower tolerance for discomfort. Addressing anxiety through predictable routines, clear communication, and calming strategies can be an important part of managing pain.

Insights, Analysis, and Developments

Editorial Note: For years, a calm face or delayed reaction from an autistic person has often been read as a sign that something didn't hurt much, and this study suggests that reading may be backward. Normal detection thresholds combined with stronger pain intensity and weaker control over prolonged pain point to people who may be feeling more than they can easily show. The practical takeaway for parents, teachers, support workers and clinicians is to assume pain is present and look for it actively, using individualized assessment tools instead of waiting for typical verbal or facial cues. This is especially important for autistic people with limited speech or intellectual disability, who the authors believe may share the same profile but have even fewer ways to report it. Treating pain early may also ease the irritability, withdrawal and sensory overload that untreated discomfort can worsen, and could lower the chance of developing a chronic pain condition later in life.*

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Wolters Kluwer Health and published on 30 Nov 2022, this content may have been edited for style, clarity, or brevity.

* Editorial additions by Ian C. Langtree.