Duerden Emma G, Taylor Margot J, Lee Minha, McGrath Patricia A, Davis Karen D, Roberts S Wendy
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
J Pain. 2015 May;16(5):463-71. doi: 10.1016/j.jpain.2015.02.001. Epub 2015 Feb 19.
Social communication deficits and repetitive behaviors are established characteristics of autism spectrum disorder (ASD) and the focus of considerable study. Alterations in pain sensitivity have been widely noted clinically but remain understudied and poorly understood. The ASD population may be at greater risk for having their pain undermanaged, especially in children with impaired cognitive ability and limited language skills, which may affect their ability to express pain. Given that sensitivity to noxious stimuli in adolescents with ASD has not been systematically assessed, here we measured warm and cool detection thresholds and heat and cold pain thresholds in 20 high-functioning adolescents with ASD and 55 typically developing adolescents using a method-of-limits quantitative sensory testing protocol. Adolescents with ASD had a loss of sensory function for thermal detection (P < .001, both warm and cool detection thresholds) but not pain threshold (P > .05, both heat and cold pain thresholds) in comparison to controls, with no evidence for significant age or sex effects (P > .05). Intelligence quotients and symptomatology were significantly correlated with a loss of some types of thermal perception in the ASD population (ie, warm detection threshold, cool detection threshold, and heat pain threshold; P < .05). Decreased thermal sensitivity in adolescents with ASD may be associated with cognitive impairments relating to attentional deficits. Our findings are consistent with previous literature indicating an association between thermal perception and cortical thickness in brain regions involved in somatosensation, cognition, and salience detection. Further brain-imaging research is needed to determine the neural mechanisms underlying thermal perceptual deficits in adolescents with ASD.
We report quantitative evidence for altered thermal thresholds in adolescents with ASD. Reduced sensitivity to warmth, coolness, and heat pain was related to impaired cognitive ability. Caregivers and clinicians should consider cognitive ability when assessing and managing pain in adolescents with ASD.
社交沟通缺陷和重复行为是自闭症谱系障碍（ASD）的既定特征，也是大量研究的重点。临床上已广泛注意到疼痛敏感性的改变，但仍研究不足且了解甚少。ASD人群可能面临疼痛管理不足的更大风险，尤其是认知能力受损和语言技能有限的儿童，这可能会影响他们表达疼痛的能力。鉴于尚未系统评估ASD青少年对有害刺激的敏感性，我们在此使用极限法定量感觉测试方案，测量了20名高功能ASD青少年和55名发育正常青少年的温热和冷觉检测阈值以及热痛和冷痛阈值。与对照组相比，ASD青少年在热觉检测方面存在感觉功能丧失（P <.001，温热和冷觉检测阈值均如此），但在疼痛阈值方面没有差异（P>.05，热痛和冷痛阈值均如此），没有明显的年龄或性别效应证据（P>.05）。智商和症状与ASD人群中某些类型的热觉丧失显著相关（即温热检测阈值、冷觉检测阈值和热痛阈值；P <.05）。ASD青少年热敏感性降低可能与注意力缺陷相关的认知障碍有关。我们的研究结果与先前的文献一致，表明热觉与参与躯体感觉、认知和显著性检测的脑区皮质厚度之间存在关联。需要进一步的脑成像研究来确定ASD青少年热觉缺陷背后的神经机制。
我们报告了ASD青少年热阈值改变的定量证据。对温暖、凉爽和热痛的敏感性降低与认知能力受损有关。照顾者和临床医生在评估和管理ASD青少年的疼痛时应考虑认知能力。
