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Pain assessment in autism: updating the ethical and methodological challenges through a state-of-the-art review

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Abstract

Sensory features of autism include hypo- or hyper-reactivity to pain; however, previous studies on pain in autism lead to conflicting results. Here, we present the state of the art and the methodological challenges concerning pain perception in autism, focusing on studies that used standardized protocol as Quantitative Sensory Testing (QST) to measure perception. Despite there are still scant evidences found with the use of QST, they have challenged the presumed hyposensitivity to pain in autisms, which emerged from parents’ reports. Both, peripheral and central mechanisms, have been found involved in typical features of perception in autism. Nonetheless, evidences with controlled protocols are still scarce, and even scarcer are studies focused on children. Overall, complex ethical challenges have to be overcome in order to collect subjective and objective measures from autistic children. With heterogeneous neurodevelopmental features, or intellectual disability, novel or modified protocols are needed.

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Acknowledgements

This work was supported by the Italian Ministry of Health (Ricerca Corrente Program 2023).

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Authors and Affiliations

  1. Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Scientific Institute IRCCS “E. Medea”, Ex Complesso Ospedaliero “A. Di Summa” - Piazza “A. Di Summa”, 72100, Brindisi, Italy

    Valentina Nicolardi, Isabella Fanizza, Giuseppe Accogli, Luigi Macchitella, Sara Scoditti & Antonio Trabacca

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  1. Valentina Nicolardi
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  2. Isabella Fanizza
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All authors contributed to the review conception and design. Preliminary searches, literature search, and data analysis were performed by Valentina Nicolardi and Antonio Trabacca. The first draft of the manuscript was written by Valentina Nicolardi, further revised by Giuseppe Accogli and Antonio Trabacca, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Antonio Trabacca.

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Nicolardi, ., Fanizza, I., Accogli, G. et al. Pain assessment in autism: updating the ethical and methodological challenges through a state-of-the-art review. Neurol Sci 44, 3853–3861 (2023). https://doi.org/10.1007/s10072-023-06942-2

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