Autistics Not Indifferent Nor Hypo-sensitive to Pain

New Evidence Questions Assumptions About Pain in Autism

Author: Wolters Kluwer Health
Published: 2022/11/30 - Updated: 2023/06/03
Peer-Reviewed: Yes
Contents: Summary - Main - Related Publications

Synopsis: This study questions the perception that people with autism experience less pain and instead suggests that they may have enhanced pain sensitivity. 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. These findings may raise physician, parent, and caregiver awareness of the pain phenomenon in autism and thus lead to early and effective treatment to improve the well-being and quality of life for autistic individuals and their families.

Autistic

Being autistic is defined as having autism or pertaining to autism. An individual affected with autism or Autism Spectrum Disorder (ASD), which affects the development of social and communication skills and can affect behavior. Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention.

Main Digest

"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.

Continued below image.
A small boy with bruises on his face and leg appears to be in pain as he sits on the end of a bench in a grassy field. A white bird is perched on the back of the bench at the other end.
A small boy with bruises on his face and leg appears to be in pain as he sits on the end of a bench in a grassy field. A white bird is perched on the back of the bench at the other end.
Continued...

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."

Attribution/Source(s):

This peer reviewed publication pertaining to our Pain: Acute and Chronic section was selected for circulation by the editors of Disabled World due to its likely interest to our disability community readers. Though the content may have been edited for style, clarity, or length, the article "Autistics Not Indifferent Nor Hypo-sensitive to Pain" was originally written by Wolters Kluwer Health, and submitted for publishing on 2022/11/30 (Edit Update: 2023/06/03). Should you require further information or clarification, Wolters Kluwer Health can be contacted at wolterskluwer.com/en. Disabled World makes no warranties or representations in connection therewith.

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