Pain sensitivity and endogenous pain modulation in autistic adults

项目摘要/摘要 由于疼痛通常是受伤或疾病的第一个迹象，个体在疼痛感知或交流方面的差异可能 危险健康状况的影响诊断和治疗。在这项提案中，我们将调查差异 由于自闭症相关的疼痛可能有沟通困难的自闭症成年人的疼痛感知 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 患有自闭症的成年人。与非自闭症患者相比，自闭症成年人报告的疼痛强度更高，疼痛相关焦虑更多 成年人。此外，自闭症成人对疼痛的神经反应模式表明中枢处理发生了变化。 痛苦的感觉。然而，这些研究中的大多数都是在40岁的自闭症年轻人中进行的。这是 由于许多痛苦的慢性疾病在成年后变得普遍(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更高， 增加了在这一人群中进行不同疼痛管理的可能性。在非自闭症人群中，年龄较大 一直与疼痛敏感度降低有关。衰老过程中疼痛的内源性调制与 中枢敏感化(促进疼痛)增加，下行疼痛调制(抑制)效率降低 痛苦)。我们的初步数据表明，患有自闭症的成年人在成年后会受到持续性疼痛的影响， 这一比例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)疼痛敏感性增加，2)内源性疼痛调制改变，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年人(n=40，30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)进行比较。研究痛觉是如何 对于自闭症成年人来说可能不同，这一探索性的R21将解决两个有针对性的知识差距。在目标1中，我们将 使用多模式(热和压力)定量感觉测试的标准电池来处理这两种感觉 以及情感上的疼痛敏感度。在目标2中，我们将检查内源性疼痛调制系统在 自闭症成人同时使用时间总和(以解决疼痛易化)和条件性疼痛调制(以 解决疼痛抑制问题)。在这项研究结束时，我们将更好地理解疼痛感知的关键差异 这可能会使患有自闭症的成年人在成年后面临持续疼痛的风险。对于自闭症成年人来说，疼痛的差异 加工和内源性疼痛调制，加上社交沟通和医疗保健方面的困难 接触，可能会导致较差的疼痛结果。从这项研究中获得的关于机械差异的知识 疼痛敏感性和内源性疼痛调制将有助于构建新疼痛发展的框架 评估工具和针对自闭症成人的有针对性的疼痛管理干预。

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.