Pain assessment in autistic people

Pain assessment in autistic people

Ruth S. Ogden, Reader in Experimental Psychology, Liverpool John Moores University
Other Contributors:
- David Moore, Reader in Pain Psychology, Liverpool John Moores University, Liverpool John Moores University
- Andrea Piovesan, Post doctoral researcher, Iuav University of Venice, Iuav University of Venice

3 February 2022

Unigwe et al., (2017)¹ rightly highlight that many GPs lack confidence in the diagnosis and management of autistic patients. GPs should however also be aware that autism can affect autistic peoples presentation when seeking care for unrelated conditions.

Here we highlight the importance of understanding altered sensory and perceptual processing when assessing pain in autistic patients.

Recent research suggests that many autistic people have altered responsivity to pain and altered perceptions of time.^2-7 This includes hyposensitivity or hypersensitivity to pain,^2-4 difficulties describing time-based information (e.g. how long something has lasted for) and difficulties managing time during daily-life.^5-7 As patient ratings of pain intensity and pain duration are fundamental to clinical assessments of pain, failure to consider how autism may affect these may hinder accurate diagnosis and treatment.

When assessing and treating pain in autistic people, the following should therefore be considered.

Autistic people may be at greater risk of pain related conditions or injury than neurotypical individuals and may therefore present more frequently.⁸
Autistic people may exhibit atypical pain presentations due to altered pain experience. Pain may therefore be reported as greater or milder than would typically be expected. Indeed, some autistic people may report pain as simply being present or absent.
Autistic people may struggle to use typical verbal and non-verbal communication skills to express the nature of their pain. Pain descriptions may therefore differ from those expected. Clinicians should therefore consider using alternative preferred communication tools to help autistic patients to provide more accurate description of their symptoms.
Autistic people often have difficulties using language to describe time (e.g., minutes, hours and weeks). This may therefore impair their ability to accurately communicate how long pain has been experienced for.
Autistic people can sometimes experience difficulties in time-based planning for future events. This may affect some patients’ abilities to adhere to temporally sensitive treatment regimes, such as remembering to take medication at specific times. It is therefore possible that some autistic patients self-administering complex medicines regimes may benefit from dosette boxes.

References

Unigwe, S., Buckley, C., Crane, L., Kenny, L., Remington, A. & Pellicano, E. GPs’ confidence in caring for their patients on the autism spectrum: an online self-report study. Br. J. Gen. Pract. 2017 67(659): e445–e452. DOI: 10.3399/bjgp17X690449.
Moore, D. J. Acute pain experience in individuals with autism spectrum disorders: A review. Autism. 2015 19(4): 387–399. DOI: 10.1177/1362361314527839.
Failla, M. D., Gerdes, M. B., Williams, Z. J., Moore, D. J. & Cascio, C. J. Increased pain sensitivity and pain-related anxiety in individuals with autism. Pain Rep. 2020, 5(6): e861. DOI: 10.1097/pr9.0000000000000861.
Vaughan, S., McGlone, F., Poole, H. & Moore, D. J. A Quantitative Sensory Testing Approach to Pain in Autism Spectrum Disorders. J. Autism Dev. Disord 2020 50(5): 1607–1620. DOI: 10.1007/s10803-019-03918-0.
Casassus, M., Poliakoff, E., Gowen, E., Poole, D. & Jones, L. A. Time perception and autistic spectrum condition: A systematic review. Autism Res. 2019 12(10): 1440–1462. DOI: 10.1002/aur.2170.
Jurek, L., Longuet, Y., Baltazar, M., Amestoy, A., Schmitt, V., Desmurget, M. & Geoffray, M.-M. (2019). How did I get so late so soon? A review of time processing and management in autism. Behav. Brain Res. 2019 374(April): 112121. DOI: 10.1016/j.bbr.2019.112121.
Poole, D., Gowen, E., Poliakoff, E., & Jones, L. A. ‘No idea of time’: Parents report differences in autistic children’s behaviour relating to time in a mixed-methods study. Autism 2021, 25(6):1797-1808. doi:10.1177/13623613211010014.
Lee, L.-C., Harrington, R. A., Chang, J. J. & Connors, S. L. Increased risk of injury in children with developmental disabilities. Res Dev Disabil. 2008 29(3): 247–255. DOI: 10.1016/j.ridd.2007.05.002.

Competing Interests: None declared.

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