Challenges in the Diagnosis and Management of Pain in Individuals with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with many systemic comorbidities, including sensory dysfunctions. A growing body of literature explored patients’ unusually intense reactions to innocuous sensory stimuli but very little is known about ASD patients’ response to noxious stimuli such as pain. Patients with ASD are thought to have low sensitivity to pain, but currently, there is no clear consensus on pain responsivity/sensitivity/expression in patients with ASD. Pain is likely a significant source of suffering for patients with ASD, but limited literature suggest that it may be underdiagnosed and undertreated, due to patients’ potentially abnormal reaction to pain/pain expression, and their limited social communication skills. In this article, we first discuss the abnormalities in pain sensitivity and expression, two key obstacles in pain management for patients with autism. Next, we explore currently available tools in pain diagnosis for patients with autism. The third, we discuss pain management in autism patient with an emphasis on the perioperative setting where literature is most abundant. Last, we call for further research and offer suggestions for implementing better pain assessment and management protocols based on our understanding of this unique population.