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).

项目概要/摘要 越来越多的文献表明，自闭症成年人与非自闭症成年人感受疼痛的方式不同，并且可能 比一般人群经历更持久的疼痛。由于疼痛通常是受伤或患病的第一个迹象， 疼痛感知或沟通的个体差异会显着影响诊断和治疗 许多健康状况。或者，如果不解决疼痛，可能会导致伤害性疼痛， 内源性系统会促进疼痛而不是抑制疼痛，从而可能导致持续性疼痛。 自闭症成年人经常会在其他感觉领域感到敏感，这可能会导致疼痛。例如， 过度反应可能包括对日常触觉刺激（例如衣服上的标签）的类似疼痛的反应。在此刻， 多项研究表明疼痛敏感性增加2,3，与疼痛相关的焦虑增加2，并且改变 自闭症患者对疼痛的神经反应1。然而，仍然存在几个重要问题，阻碍了 改善自闭症患者的疼痛治疗。在这个项目中，我们建议解决我们当前的几个差距 理解，建立一个框架来研究自闭症的疼痛敏感性。首先，我们要解决疼痛 自闭症成人的疼痛评估和表达。目前，对于疼痛尚无共识建议 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 测试自我报告的自闭症成人的不同疼痛量表以确定可靠性。此外，我们将评估 这些量表上的疼痛评级如何与可观察到的疼痛行为相对应。其次，我们将解决潜在的问题 可能预测自闭症持续疼痛的因素。目前尚不清楚对疼痛的过敏是否从 自闭症成人的普遍感觉超敏反应。在目标 2 中，我们将探索个人的感官特征 反应性来识别疼痛和其他感觉领域的敏感性之间的重要关系。我们也会 探索可能影响持续性疼痛的社会和情感因素的关系。最后，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。我们之前的工作表明自闭症 成年人的体感脑区和情感脑区对热痛有不同的神经反应，但 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 清除。总的来说，我们假设患有自闭症的成年人很难表达他们的痛苦，使他们处于一种 疼痛处理不当的风险更大。此外，我们假设自闭症成年人可能有一个亲 伤害感受会增加疼痛的程度。这种困难的疼痛沟通和亲和力的结合 伤害性特征使自闭症患者面临持续疼痛的风险，并且不利于他们的整体健康。 在这个项目结束时，我们的工作可以告诉临床医生如何评估自闭症的疼痛（目标 1），识别 自闭症患者最有可能出现持续性疼痛（目标 2），并激发新的机制来改善疼痛 成人自闭症患者的管理（目标 3）。