Autism & pain

In the previous post, I described my recent experience at the dentist, where I was questioned about my pain threshold which was perceived to be higher than average. If you want to read that experience first, have a look at the post below. In this post, I will have a look at the research literature. Do autistic people indeed have a higher pain threshold?

Dentistry & pain threshold

Pain threshold

So is my pain threshold higher than usual? I don’t really know. But I have looked at the research literature on autism and pain sensitivity, and the findings are interesting!

In 2013, forensic psychologist and autism researcher Clare Allely published a review paper where she identified 15 studies investigating pain autistic individuals, resulting in the following findings:^[1]Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder

• All 15 case studies reported pain insensitivity in autistic individuals.
• The majority of the 10 experimental studies reviewed indicate that the idea that autistics are pain insensitive needs to be challenged. No kidding, right?
• It’s possible not all autistic children express their physical discomfort in the same way neurotypical children would (i.e., cry, moan, seek comfort, etc.), which makes others including medical professionals and caregivers interpret the response as pain insensitivity or leading to the belief that the child is experiencing no pain.

In 2014, senior lecturer in psychology and autism & pain researcher David Moore published a review that focused not only on differences in the behavioral response to pain (i.e. signs of pain-related distress) but also on the subjective experience of pain (i.e. different pain thresholds). 7 studies were looked at, including Allely’s review study. The findings expand on Allely’s last point:^[2]Acute pain experience in individuals with autism spectrum disorders: A review

• Both self/parent report and clinical observations appeared to report hyposensitivity to pain (i.e. reduced sensitivity to pain), whereas;
• Observations of medical procedures and experimental manipulation suggested normal or even hypersensitive responses to pain (i.e. increased sensitivity to pain).

So it seems our pain threshold generally doesn’t differ much from neurotypicals, and we may even be MORE sensitive to pain. But as we are less expressive about it, we appear to have a higher pain threshold.

Subjective pain

But the fact remains that my experience at the dentist was not one of predominant pain. And even the discomfort was often so low that there were definite moments of relaxation. It makes me wonder about my subjective experience of pain. I already alluded in Sensory Sunday #1 that there can be stark differences in the subjective experience of things, even if the same sensations occur. I can think of several possibilities regarding my subjective experience of pain:

1. I have a reduced experience of pain due to hyposensitivity.
2. I have a reduced experience of pain because I am less expressive about my pain, which in turn influences my subjective experience of it.
3. I have a regular experience of pain but I process pain differently, thus leading to underreporting pain.
4. I have a regular experience of pain, but my short-term memory causes me to forget the pain and always underreport because the information of the subjective experience is lost in the past.
5. I may have a regular or increased experience of pain, but for some reason I am less expressive of my experience, which leads me to think it can’t be all that painful.

Honestly, #4 and #5 don’t seem plausible to me, as my short-term memory isn’t that dysfunctional, or at all; and though illusory (pain) sensations may be, I don’t think I am less aware of what would otherwise be an increased experience of pain.

So whether it’s #1, #2, or #3, it does seem to amount to a higher pain threshold.

Pain processing

A small study from 2016 by Yuka Yasuda et al. based on 15 autistics and 15 controls showed some interesting findings. The pain detection threshold and pain tolerance of autistic individuals were not impaired, so there were no differences in the somatic perception of pain between groups. However:^[3]Sensory cognitive abnormalities of pain in autism spectrum disorder: a case–control study

• Autistics were hyposensitive to subjective pain intensity compared to controls (VAS; electrical: p = 0.044, cold: p = 0.011, heat: p = 0.042) and;
• Autistics were hyposensitive to affective aspects of pain sensitivity (SF-MPQ; electrical: p = 0.0071, cold: p = 0.042).

These results suggest that the cognitive pathways for pain processing function differently in autism. So it seems this study indicates that hypothesis #3 from the previous section was correct!

I also wonder, then, if it’s not autism but alexithymia that alters the cognitive pathways for pain.

What is your experience? Would you say your pain threshold is higher? What about your pain sensitivity?