Measurement and Mechanisms of Pain in Autistic Adults

项目总结/摘要 越来越多的文献表明，自闭症成年人感受疼痛的方式与非自闭症成年人不同， 比一般人群经历更多的持续性疼痛。由于疼痛往往是受伤或生病的第一个迹象， 疼痛感知或沟通的个体差异可显著影响 许多健康状况。或者，当疼痛没有得到解决时，这可能导致促伤害性疼痛特征， 其中内源性系统促进疼痛而不是抑制疼痛，可能导致持续性疼痛。 自闭症成年人经常在其他感觉领域体验到敏感性，这些敏感性可能会延伸到疼痛。比如说， 高反应性可以包括对日常触觉刺激（如衣服上的标签）的疼痛样反应。在这一点上， 几项研究表明，疼痛敏感性增加2，3，疼痛相关焦虑增加2， 孤独症患者对疼痛的神经反应然而，仍然存在着几个重要问题， 改善自闭症患者的疼痛治疗。在这个项目中，我们建议解决我们目前的几个差距， 理解，建立一个框架来研究自闭症的疼痛敏感性。首先，我们将解决疼痛问题， 评估和表达自闭症成人的疼痛。目前，对疼痛没有一致的建议 自闭症评估目前尚不清楚自闭症患者是否以不同于非自闭症患者的特定方式表达疼痛。 自闭症患者，如果更好的疼痛评估工具将改善疼痛管理。在目标1中，我们建议 在自我报告的自闭症成年人中测试不同的疼痛量表，以确定可靠性。此外，我们将评估 这些量表上的疼痛等级如何对应于可观察到的疼痛行为。第二，我们将探讨潜在的 可能预测自闭症持续疼痛的因素。目前尚不清楚对疼痛的超敏反应是否从 自闭症患者的一种普遍的感觉超敏反应在目标2中，我们将探索感官的个体特征， 反应性，以确定疼痛和其他感觉领域的敏感性之间的重要关系。我们还将 探索与可能影响持续性疼痛的社会和情感因素的关系。在目标3中，我们将 解决自闭症成人疼痛敏感性的潜在大脑机制。我们之前的研究表明自闭症患者 成年人在躯体感觉和情感脑区对热痛有不同的神经反应， 这些区域的功能连接以及神经反应和疼痛报告之间的关系并不 清楚总的来说，我们假设自闭症成年人难以表达他们的痛苦，使他们处于一种痛苦的状态。 疼痛管理不当的风险更大。此外，我们假设自闭症成年人可能有一个亲- 增加疼痛程度的伤害性特征。这种困难的痛苦沟通和亲- 伤害性特征使自闭症个体处于持续疼痛的风险中，并且对他们的整体健康有害。 在这个项目的结论，我们的工作可以告知临床医生如何评估自闭症疼痛（目标1）， 孤独症患者持续疼痛的风险最高（目标2），并激发新的机制来改善疼痛 成人自闭症管理（Aim 3）。

Project Summary/Abstract A growing literature suggests autistic adults feel pain in a different manner than non-autistic adults and may experience more persistent pain than the general population. As pain is often the first sign of injury or illness, individual differences in pain perception or communication can significantly impact diagnosis and treatment of many health conditions. Alternatively, when pain is not addressed, this can lead to a pro-nociceptive pain profile, where endogenous systems facilitate pain instead of inhibiting it, potentially contributing to persistent pain. Autistic adults often experience sensitivity in other sensory domains that could extend to pain. For example, hyper-responsiveness can include pain-like reactions to everyday tactile stimuli like tags on clothing. At this point, several studies have demonstrated increased pain sensitivity2,3, increased pain-related anxiety2, and altered neural responses to pain1 in autistic individuals. Yet, several important questions remain that present barriers to improving pain treatment in autistic individuals. In this project, we propose to address several gaps in our current understanding, building a framework to investigate pain sensitivity in autism. First, we will address pain assessment and expression of pain in autistic adults. Currently, there is no consensus recommendation on pain assessment in autism. It is not clear if autistic individuals express pain in specific ways that differ from non- autistic individuals and if better pain assessment tools would improve pain management. In Aim 1, we propose to test different pain scales in self-reporting autistic adults to determine reliability. Additionally, we will assess how pain ratings on these scales correspond to observable pain behaviors. Secondly, we will address potential factors that may predict persistent pain in autism. It is currently unknown if hypersensitivity to pain extends from a general sensory hypersensitivity for autistic adults. In Aim 2, we will explore individual profiles of sensory reactivity to identify important relationships between pain and sensitivity in other sensory domains. We will also explore relationships with social and emotional factors that may impact persistent pain. Lastly, in Aim 3, we will address potential brain mechanisms of pain sensitivity in autistic adults. Our previous work indicated that autistic adults have a different neural response to heat pain across somatosensory and affective brain regions, but the functional connectivity of these regions and the relationship between neural responses and pain reports is not clear. Overall, we hypothesize that autistic adults have difficulty communicating their pain, leaving them at a greater risk for mismanagement of pain. Additionally, we hypothesize that autistic adults likely have a pro- nociceptive profile increasing the magnitude of pain. This combination of difficult pain communication and a pro- nociceptive profile leaves autistic individuals at risk for persistent pain and is a detriment to their overall health. At the conclusion of this project, our work could inform how clinicians assess pain in autism (Aim 1), identify autistic individuals at most risk for persistent pain (Aim 2) and spark new mechanisms to improve pain management in autistic adults (Aim 3).