Do autistics feel more pain or less pain?

There is too much variation to make broad statements when it comes to pain sensitivity among autistic people. With some characteristics, there are clear trends. This is not so with pain.

In some studies, autistic people have been found to experience regular or increased pain responsiveness (i.e. Fan et al. 2014; Riquelme, Hatem and Montoya 2016). In other studies, autistic people experience less pain reactivity or even none of it (i.e. Allely 2013; Tordjman et al. 2018).

Historically, I can miss pain signals.

There was a day that I won’t ever forget. Actually, let me get to the punchline and skip most of the drawn out story.

It was around 2008, and I was very excited to be invited to play a pickup game of tennis. I was so very excited that I kicked off the dress shoes from my feet and proceeded to play tennis on a hard surface court in the sun, for no less than three hours.

My ability to hyperfocus, while something of an un-aim-able laser, is often impressive, and it certainly was that day. I played numerous sets of tennis, through a number of opponents, all while barefoot.

And the bottom of my feet were substantially injured from this, a result that completely surprised me when I had run out of people willing to play tennis with me and thus had returned to put my socks and dress shoes back on.

And this is unrelated to pain responsiveness, but it’s not unrelated to being neurodivergent. This is ADHD. This is an example of hyperfocus.

Presently, I feel all the pain.

At the time of this writing, it seems that my central nervous system is either caught in one heck of a status migraine or stuck in a sort of prolonged pain response itself. Diagnosis is still pending, but everything hurts.

For one example, I have gastroparesis, as diagnosed by imaging. But I have the pain-predominant type versus the nausea-predominant type.

I basically feel my stomach fighting me about doing its one job, and I feel it at upper abdominal pain, but it’s literally my stomach reluctantly doing a half-a** job of being a stomach.

That’s a trip, isn’t it?

But this isn’t about pain responsiveness in the way that it’s normally studied either, because I didn’t have any abdominal pain at all until 2022.

Before 2022, I would have said that I probably have normal pain responsiveness, except when I’m hyperfocused on something such as a willing tennis partner.

Importantly, researchers do seem to consider that pain perception with autistics is at least somewhat of a paradox (Bogdanova et al. 2022). In my own personal experience, I’ve certainly run the full range and still don’t quite know how to interpret what I’m experiencing…

Fellow neurodivergent folks, how about you? 

If you would like to discuss this topic, there is a post about it on the Autistic PhD facebook page.

References

Allely, C. S. 2013. “Pain Sensitivity and Observer Perception of Pain in Individuals with Autistic Spectrum Disorder.” The Scientific World Journal 2013:1-20. doi: http://dx.doi.org/10.1155/2013/916178.

Bogdanova, Olena V., Volodymyr B. Bogdanov, Adrien Pizano, Manuel Bouvard, Jean-Rene Cazalets, Nicholas Mellen and Anouck Amestoy. 2022. “The Current View on the Paradox of Pain in Autism Spectrum Disorders.” Frontiers in Psychiatry 13. doi: https://doi.org/10.3389/fpsyt.2022.910824.

Fan, Yang-Teng, Chenyi Chen, Shih-Chuan Chen, Jean Decety and Yawei Cheng. 2014. “Empathic Arousal and Social Understanding in Individuals with Autism: Evidence from Fmri and Erp Measurements.” Social Cognitive and Affective Neuroscience 9(8):1203-13. doi: https://doi.org/10.1093/scan/nst101.

Riquelme, Inmaculada, Samar M. Hatem and Pedro Montoya. 2016. “Abnormal Pressure Pain, Touch Sensitivity, Proprioception, and Manual Dexterity in Children with Autism Spectrum Disorders.” Neural Plasticity 2016:1723401. doi: https://doi.org/10.1155/2016/1723401.

Tordjman, Sylvie, George M Anderson, Annaelle Charrier, Cecile Oriol, Solenn Kermarrec, Roberto Canitano, Michel Botbol, Nathalie Coulon, Corinne Antoine and Sylvie Brailly-Tabard. 2018. “Relationships between Self-Injurious Behaviors, Pain Reactivity, and Β-Endorphin in Children and Adolescents with Autism.” The Journal of Clinical Psychiatry 79(2):19558. doi: https://doi.org./10.4088/JCP.16m10889.