Failla Michelle D, Gerdes Madison B, Williams Zachary J, Moore David J, Cascio Carissa J
Department of Psychiatry and Behavioral Science, Vanderbilt University, Nashville, TN, USA.
Medical Scientist Training Program, Vanderbilt University, Nashville, TN, USA.
Pain Rep. 2020 Nov 16;5(6):e861. doi: 10.1097/PR9.0000000000000861. eCollection 2020 Nov-Dec.
Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli. Previous neuroimaging work suggests altered pain evaluation could contribute to pain-related anxiety in ASD.
We hypothesized that individuals with ASD would report increased pain sensitivity and endorse more pain-related anxiety, compared to typically developing controls.
We recruited 43 adults (ASD, n = 24; typically developing, n = 19) for 3 heat pain tasks (applied to the calf). We measured heat pain thresholds using a method of limits approach, a pain-rating curve (7 temperatures between 40 and 48°C, 5 seconds, 5 trials each), and a sustained heat pain task with alternating low (42°C) and high (46°C) temperatures (21 seconds, 6 trials each). Individual differences in pain-related anxiety, fear of pain, situational pain catastrophizing, depressive symptoms, and autism-related social communication were assessed by self-report.
There were no group differences in pain thresholds. For suprathreshold tasks, mean pain ratings were higher in ASD across both the pain-rating curve and the sustained heat pain tasks, but responses in the ASD group were more varied. Pain anxiety (PASS-Total) and pain-related fear (FOP-III-Total) were higher in the ASD group and were positively associated with pain ratings.
Our results suggest that both sensory and cognitive experiences of pain are heightened and interact reciprocally in adults with ASD. Future studies are needed to evaluate the impact of pain-related anxiety on treatment-seeking and pain behaviors, given higher levels of pain-related anxiety in ASD.
自闭症谱系障碍（ASD）患者通常在疼痛反应方面存在差异。这种反应性的改变可能与ASD相关的社交沟通困难、感觉差异或疼痛刺激处理改变有关。先前的神经影像学研究表明，疼痛评估改变可能导致ASD患者出现与疼痛相关的焦虑。
我们假设，与发育正常的对照组相比，ASD患者会报告更高的疼痛敏感性，并认可更多与疼痛相关的焦虑。
我们招募了43名成年人（ASD组24人；发育正常组19人）进行3项热痛任务（应用于小腿）。我们使用极限法测量热痛阈值、疼痛评分曲线（40至48°C之间的7个温度，每次5秒，各进行5次试验）以及持续热痛任务，其中交替使用低温（42°C）和高温（46°C）（每次21秒，各进行6次试验）。通过自我报告评估与疼痛相关的焦虑、对疼痛的恐惧、情境性疼痛灾难化、抑郁症状以及与自闭症相关的社交沟通方面的个体差异。
两组在疼痛阈值上没有差异。对于阈上任务，在疼痛评分曲线和持续热痛任务中，ASD组的平均疼痛评分均更高，但ASD组的反应更为多样。ASD组的疼痛焦虑（PASS总分）和与疼痛相关的恐惧（FOP-III总分）更高，且与疼痛评分呈正相关。
我们的结果表明，ASD成年人的疼痛感觉和认知体验均增强，且相互作用。鉴于ASD患者中与疼痛相关的焦虑水平较高，未来需要开展研究来评估与疼痛相关的焦虑对寻求治疗和疼痛行为的影响。
