Han Gloria T, Heavner Holly S, Rains Thomas R, Hoang Alan H, Stone Amanda L
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Pediatric Rehabilitation, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Children (Basel). 2024 Mar 6;11(3):312. doi: 10.3390/children11030312.
Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical records and discussions by an interdisciplinary pain treatment team were summarized to inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth. Our sample included a record review of 95 patients receiving treatment in an interdisciplinary outpatient pediatric pain clinic. Results indicated that 9% ( = 9) of the patients presented to the clinic with a prior diagnosis of autism, but an additional 21% ( = 20) were identified as likely meeting criteria for autism based on the clinical assessment of the developmental history, behaviors observed during the clinical encounter(s), and expert clinical judgment, suggesting that the prevalence rate of autism may be closer to 30% in our outpatient pediatric pain clinic. Over half (52%) of the autistic youth presented to the clinic with widespread pain, 60% identified as female, and 6% identified as gender expansive or transgender. Qualitative insights revealed that most of the autistic patients had co-occurring sensory-processing challenges and difficulty in describing their pain, emotions, and somatic experiences and exhibited cognitive inflexibility and social challenges. We summarize our team's clinical reflections on how autism-relevant biopsychosocial vulnerability factors may contribute to the experience of pain in autistic youth and propose treatment targets and adaptations for the assessment and treatment of pain in this population. Finally, we recommend the need for interventions focused on sensorimotor integration, especially for autistic youth, and describe how pain clinics may be particularly helpful for identifying and supporting autistic females, for whom the potential role of autism in pain experiences had not been considered until receiving treatment in our clinic.
尽管慢性疼痛诊所中自闭症患者的比例过高这一现象越来越受到关注，但针对这一人群慢性疼痛评估和治疗的潜在调整方法尚未确立。为了填补这一空白，我们总结了电子病历的回顾性分析以及跨学科疼痛治疗团队的讨论结果，以了解影响自闭症青少年慢性疼痛表现、评估和治疗的潜在生物心理社会因素。我们的样本包括对在一家跨学科儿科门诊疼痛诊所接受治疗的95名患者的病历回顾。结果表明，9%（n = 9）的患者在就诊前被诊断为自闭症，但根据发育史的临床评估、临床会诊期间观察到的行为以及专家临床判断，另有21%（n = 20）的患者被确定可能符合自闭症标准，这表明在我们的儿科门诊疼痛诊所中，自闭症的患病率可能接近30%。超过一半（52%）的自闭症青少年因广泛疼痛前来就诊，60%为女性，6%为性别认同扩展者或跨性别者。定性分析结果显示，大多数自闭症患者同时存在感觉处理方面的挑战，难以描述自己的疼痛、情绪和躯体体验，并且表现出认知灵活性和社交方面的问题。我们总结了团队关于与自闭症相关的生物心理社会脆弱因素如何可能导致自闭症青少年疼痛体验的临床思考，并提出了针对这一人群疼痛评估和治疗的目标及调整方法。最后，我们建议需要开展侧重于感觉运动整合的干预措施，尤其是针对自闭症青少年，并描述了疼痛诊所如何可能特别有助于识别和支持自闭症女性，在她们来我们诊所接受治疗之前，自闭症在疼痛体验中的潜在作用一直未被考虑。
