Pain sensitivity and endogenous pain modulation in autistic adults

项目总结/摘要 由于疼痛通常是受伤或疾病的第一个迹象，疼痛感知或沟通的个体差异可以 影响危险健康状况的诊断和治疗。在本建议书中，我们将调查 在疼痛感知的自闭症成年人谁可能有困难的沟通疼痛，由于自闭症相关的 沟通困难。新出现的证据表明，自闭症成年人的疼痛体验与非自闭症成年人不同。 自闭症成年人与非自闭症患者相比，自闭症成年人报告了更高的疼痛强度和更多与疼痛相关的焦虑 成年人了此外，自闭症成年人对疼痛的神经反应模式表明， 痛苦然而，大多数这些研究都是在年轻的自闭症成年人（<40岁）中进行的。这是 考虑到许多痛苦的慢性医学病症在成年中期变得普遍（例如，背痛， 关节炎，糖尿病），报告表明自闭症成年人经历这些情况的几率甚至更高， 增加了这一人群中不同疼痛管理的可能性。在非自闭症人群中， 与疼痛敏感性降低有关衰老过程中疼痛的内源性调节与 中枢敏感性增加（疼痛易化），下行疼痛调节效率降低（抑制 疼痛）。我们的初步数据表明，自闭症成年人在成年后会受到持续性疼痛的影响， 这随着年龄的增长而增加。我们的概念框架表明，自闭症成年人可能会经历持续的疼痛， 在成年期，由于3个因素：1）增加的疼痛敏感性，2）改变内源性疼痛调制，和3） 疼痛评估困难。 这项横断面研究的总体目标是调查自闭症成人（n=40，年龄30- 40岁）的疼痛差异。 70岁）与年龄、种族和性别匹配的非自闭症成年人（n=40）相比。为了研究疼痛感知 可能会有所不同的自闭症成年人，这个探索性的R21将解决两个有针对性的知识差距。在目标1中，我们 使用一套标准的多模态（热和压力）定量感官测试，以解决两种感官 和情感疼痛敏感性。在目标2中，我们将研究内源性疼痛调节系统的差异， 使用时间总和（以解决疼痛促进）和条件性疼痛调制（以 解决疼痛抑制）。在本研究结束时，我们将更好地了解疼痛感知的关键差异 这可能会使自闭症成年人在成年后面临持续性疼痛的风险。对于自闭症成年人来说， 处理和内源性疼痛调节，加上社交和医疗保健困难 可能导致不良的疼痛结局。从这项研究中获得的关于 疼痛敏感性和内源性疼痛调节将有助于建立一个新的疼痛发展框架 评估工具和针对自闭症成年人的疼痛管理干预措施。

Project Summary/Abstract As pain is often the first sign of injury or illness, individual differences in pain perception or communication can impact diagnosis and treatment of dangerous health conditions. In this proposal, we will investigate differences in pain perception for autistic adults who may have difficulty communicating about pain due to autism-related communication difficulties. Emerging evidence suggests autistic adults experience pain differently than non- autistic adults. Autistic adults report higher pain intensity and more pain-related anxiety compared to non-autistic adults. Additionally, the pattern of neural responses to pain in autistic adults suggests altered central processing of pain. However, most of these studies have been conducted in younger autistic adults (<40yrs). This is concerning as many painful chronic medical conditions become prevalent in mid-adulthood (e.g., back pain, arthritis, diabetes) and reports suggest autistic adults experience these conditions are an even greater rate, increasing the potential for disparate pain management in this population. In non-autistic populations, older age is consistently associated with decreased pain sensitivity. Endogenous modulation of pain in aging is associated with increased central sensitization (facilitation of pain), and less efficient descending pain modulation (inhibition of pain). Our preliminary data suggests that autistic adults are affected with persistent pain in adulthood and that this increases with age. Our conceptual framework suggests that autistic adults may experience persistent pain in adulthood due to 3 factors: 1) increased pain sensitivity, 2) altered endogenous pain modulation, and 3) difficulty in pain assessment. The overall goal of this cross-sectional study is to investigate how pain differs in autistic adults (n=40, ages 30- 70 yrs) compared to age, race, and sex matched non-autistic adults (n=40). To examine how pain perception may differ for autistic adults, this exploratory R21 will address two targeted knowledge gaps. In Aim 1, we will use a standard battery of multi-modality (heat and pressure) quantitative sensory testing to address both sensory and affective pain sensitivity. In Aim 2, we will examine differences in endogenous pain modulatory systems in autistic adults using both temporal summation (to address pain facilitation) and conditioned pain modulation (to address pain inhibition). At the end of this study, we will better understand critical differences in pain perception that may place autistic adults at risk for persistent pain in adulthood. For autistic adults, differences in pain processing and endogenous pain modulation, coupled with difficulty in social communication and healthcare access, could lead to poor pain outcomes. The knowledge gained from this study on mechanistic differences in pain sensitivity and endogenous pain modulation will help build a framework for development of new pain assessment tools and targeted pain management interventions for autistic adults.