Measurement and Mechanisms of Pain in Autistic Adults

成人自闭症患者疼痛的测量和机制

• 批准号: 10718172
• 负责人: Michelle Dawn Failla
• 金额: $ 52.61万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10718172
• 关键词: Address; Adult; Affect; Affective; Anterior; Anxiety; Behavior; Brain; Brain region; Clothing; Communication; Consensus; Data; Diagnosis; Emotions; Evaluation; Facial Pain; Functional Magnetic Resonance Imaging; General Population; Health; Hypersensitivity; Individual; Individual Differences; Injury; Insula of Reil; Intervention; Literature; Maps; Measurement; Measures; Nociception; Pain; Pain Assessment Tool; Pain Measurement; Pain management; Participant; Patient Self-Report; Persistent pain; Persons; Proxy; Psychophysics; Reaction; Recommendation; Reporting; Research; Risk; Sensory; Signal Transduction; Somatosensory Cortex; Stimulus; System; Tactile; Testing; Visual; Work; adult with autism spectrum disorder; analog; autism spectrum disorder; autistic; clinically relevant; emotional factor; experience; improved; individuals with autism spectrum disorder; neural; pain behavior; pain perception; pain processing; pain scale; pain sensitivity; pressure; response; social communication; social factors; somatosensory; verbal

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).

项目摘要/摘要 越来越多的文献表明自闭症成年人的疼痛与非自动成年人不同，可能 比普通人群体验更多的持续疼痛。由于疼痛通常是受伤或疾病的第一个迹象，所以 疼痛感知或沟通方面的个体差异可以显着影响 许多健康状况。或者，当未解决疼痛时，这可能会导致亲人的疼痛特征， 在内源系统促进疼痛而不是抑制疼痛的地方，有可能导致持续的疼痛。 自闭症成年人经常在其他可能延伸至疼痛的感觉领域中会经历灵敏度。例如， 高反应性可以包括对日常触觉刺激的疼痛反应，例如衣服上的标签。在此刻， 几项研究表明疼痛敏感性增加2,3，增加了与疼痛相关的焦虑2，并改变了 自闭症患者对疼痛的神经反应。然而，仍然存在一些重要的问题 改善自闭症患者的疼痛治疗。在这个项目中，我们建议解决当前的几个空白 理解，建立一个框架来研究自闭症的疼痛敏感性。首先，我们将解决痛苦 自闭症成年人疼痛的评估和表达。目前，关于痛苦没有共识的建议 自闭症评估。尚不清楚自闭症患者是否以与非非 - 不同的特定方式表达疼痛 自闭症患者以及更好的疼痛评估工具将改善疼痛管理。在AIM 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。其次，我们将解决潜力 可能预测自闭症持续疼痛的因素。目前尚不清楚疼痛的超敏反应是否从 自闭症成年人的一般感觉超敏反应。在AIM 2中，我们将探索感官的个人概况 反应性以确定其他感觉域中疼痛与灵敏度之间的重要关系。我们也会 探索与可能影响持续痛苦的社会和情感因素的关系。最后，在AIM 3中，我们将 解决自闭症成年人疼痛敏感性的潜在大脑机制。我们以前的工作表明自闭症 成年人对跨体感和情感大脑区域的热疼痛的神经反应不同，但是 这些区域的功能连通性以及神经反应与疼痛报告之间的关系不是 清除。总体而言，我们假设自闭症成年人很难传达痛苦，使他们处于 疼痛管理不善的风险更大。此外，我们假设自闭症成年人可能具有 伤害性特征增加了疼痛的幅度。困难的疼痛交流和亲和力的结合 伤害性的特征使自闭症患者处于持续疼痛的风险中，并损害了他们的整体健康状况。 在该项目结束时，我们的工作可以告知临床医生如何评估自闭症的疼痛（AIM 1），确定 自闭症患者有持续疼痛的风险（目标2），并引发新的机制以改善疼痛 自闭症成年人的管理（AIM 3）。