Challenges in the Diagnosis and Management of Pain in Individuals with Autism Spectrum Disorder

Li, Jun; Chen, Lucy; Shen, Shiqian; Mao, Jianren; Lopes, Maria Saudade Oliveira Custódio; Liu, Siyu; Kong, Xuejun

doi:10.1007/s40489-020-00199-7

Cited by 16 publications

(8 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These abnormalities contribute to ASD core symptoms such as social and communication deficits and are considered primary characteristics of ASD neurobiology. 64 Abnormalities in processing tactile and pain sensitivity, ranging from exaggerated response to touch, stimuli hyposensitivity, and self-harming, have been reported in individuals with ASD 10 , 17 , 44 , 46 , 52 , 62 , 63 , 69 and in rodent models 65 and are consistent with data reported herein. For example, Htr3a knockout mice were reported previously to display impaired pain response to formalin, 80 but no other behavioral data related to ASD-like phenotypes were reported.…”

Section: Discussionsupporting

confidence: 88%

Identifying genetic determinants of inflammatory pain in mice using a large-scale gene-targeted screen

Wotton

Peterson

Flenniken

et al. 2021

Pain

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 88%

Identifying genetic determinants of inflammatory pain in mice using a large-scale gene-targeted screen

Wotton

Peterson

Flenniken

et al. 2021

Pain

View full text Add to dashboard Cite

show abstract

“…Diagnosis and follow-up of concomitant diseases (comorbidities) in individuals with ASD do involve several problems [18,19]. Based on our ndings 80.6% of physicians and 63.6% of students and residents, who had to interact with patients diagnosed with ASD in their medical practice, had di culties in the diagnosis or follow-up of concomitant disorders for these patients.…”

Section: Resultsmentioning

confidence: 75%

Health Care Providers’ Awareness on Medical Management of Children With Autism Spectrum Disorder: Cross-Sectional Study in Russia

Mukhamedshina

Fayzullina

Nigmatullina

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Autism spectrum disorder (ASD) is a complex developmental range of conditions that involves difficulties with social interaction and restricted/repetitive behaviors. Unfortunately, health care providers often experience difficulties in diagnosis and management of individuals with ASD and may have no knowledge about possible ways to overcome barriers in ASD patient interactions in healthcare settings. At the same time, the provision of appropriate medical services can have positive effects on habilitative progress, functional outcome, life expectancy and quality of life for individuals with ASD.Methods: This online survey designed research study evaluated the awareness and experience of students/residents (n=247) and physicians (n=100) in medical management of children with ASD, as well as the views and experiences of caregivers of children on the autism spectrum (n=158), all based in Russia.Results: We have established that the Russian medical community has limited ASD knowledge among providers, and have suggested possible reasons for this. Based on the online survey of students/residents, non-psychiatric physicians and caregivers of children diagnosed with ASD, the main problems pertaining to medical management of individuals with ASD were identified, and possible problem solving solutions within medical practice were proposed.Conclusions: Results of this study should be considered both when implementing measures to improve healthcare practices, and in developing models of effective medical management due to start in not only in Russia but also in a number of other countries.

show abstract

“…However, pain sensitivity may be expressed through unusual responses 36,74 mistakenly interpreted by health professions as anxiety, nausea, or delirium in acute pain situations. 44,72 Autistic individual pain hypersensitivity was manifested in our findings through various suprathreshold heat stimuli: single phasic (first and last stimuli in the TS test), repetitive phasic (at 46, 49, 52˚C, and at pain-50 phasic determined temperature), and tonic (at pain-50 tonic determined temperature and hand immersion in a hot water bath). These results are to some extent similar to those of the recent studies, 27,31 together supporting the E/I imbalance impact on the pain system, specifically the pain pathways transmitting excitation.…”

Section: Discussionmentioning

confidence: 71%

“…However, pain sensitivity may be expressed through unusual responses 36,74 mistakenly interpreted by health professions as anxiety, nausea, or delirium in acute pain situations. 44,72…”

Section: Discussionmentioning

confidence: 99%

Indifference or hypersensitivity? Solving the riddle of the pain profile in individuals with autism

Hoffman

Bar-Shalita

Granovsky

et al. 2022

Pain

View full text Add to dashboard Cite

Excitatory-inhibitory (E/I) imbalance is a mechanism that underlies autism spectrum disorder, but it is not systematically tested for pain processing. We hypothesized that the pain modulation profile (PMP) in autistic individuals is characterized by less efficient inhibitory processes together with a facilitative state, indicative of a pronociceptive PMP. Fifty-two adults diagnosed with autism and 52 healthy subjects, age matched and sex matched, underwent quantitative sensory testing to assess the function of the (1) pain facilitatory responses to phasic, repetitive, and tonic heat pain stimuli and (2) pain inhibitory processes of habituation and conditioned pain modulation. Anxiety, pain catastrophizing, sensory, and pain sensitivity were self-reported. The autistic group reported significantly higher pain ratings of suprathreshold single (P 5 0.001), repetitive (46˚C-P 5 0.018; 49˚C-P 5 0.003; 52˚C-P , 0.001), and tonic (P 5 0.013) heat stimuli that were cross correlated (r 5 0.48-0.83; P , 0.001) and associated with sensitivity to daily life pain situations (r 5 0.39-0.45; P , 0.005) but not with psychological distress levels. Hypersensitivity to experimental pain was attributed to greater autism severity and sensory hypersensitivity to daily stimuli. Subjects with autism efficiently inhibited phasic but not tonic heat stimuli during conditioned pain modulation. In conclusion, in line with the E/I imbalance mechanism, autism is associated with a pronociceptive PMP expressed by hypersensitivity to daily stimuli and experimental pain and less-efficient inhibition of tonic pain. The latter is an experimental pain model resembling clinical pain. These results challenge the widely held belief that individuals with autism are indifferent to pain and should raise caregivers' awareness of pain sensitivity in autism.

show abstract

Challenges in the Diagnosis and Management of Pain in Individuals with Autism Spectrum Disorder

Cited by 16 publications

References 87 publications

Identifying genetic determinants of inflammatory pain in mice using a large-scale gene-targeted screen

Identifying genetic determinants of inflammatory pain in mice using a large-scale gene-targeted screen

Health Care Providers’ Awareness on Medical Management of Children With Autism Spectrum Disorder: Cross-Sectional Study in Russia

Indifference or hypersensitivity? Solving the riddle of the pain profile in individuals with autism

Contact Info

Product

Resources

About