Increased pain sensitivity and pain-related anxiety in individuals with autism

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Failla, M. D., Gerdes, M., Williams, Z. J., Moore, D., & Cascio, C. J. (2020). Increased pain sensitivity and pain-related anxiety in individuals with autism. PAIN Reports, 5(6), e861. https://doi.org/10.1097/pr9.0000000000000861

Publication date: 1 Nov 2020 Added to AutiHub: 7 Jul 2026 Type: Article Article language: English
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Authors

Publication authors
5
Publication authors identified as autistic
1 / 5 (20.0%)
  1. Michelle D. Failla
  2. Madison Gerdes
  3. Zachary J. Williams *
  4. David Moore
  5. Carissa J. Cascio

Abstract

INTRODUCTION: Individuals with autism spectrum disorder (ASD) often exhibit differences in pain responsivity. This altered responsivity could be related to ASD-related social communication difficulties, sensory differences, or altered processing of pain stimuli. Previous neuroimaging work suggests altered pain evaluation could contribute to pain-related anxiety in ASD. OBJECTIVES: We hypothesized that individuals with ASD would report increased pain sensitivity and endorse more pain-related anxiety, compared to typically developing controls. METHODS: We recruited 43 adults (ASD, n = 24; typically developing, n = 19) for 3 heat pain tasks (applied to the calf). We measured heat pain thresholds using a method of limits approach, a pain-rating curve (7 temperatures between 40 and 48°C, 5 seconds, 5 trials each), and a sustained heat pain task with alternating low (42°C) and high (46°C) temperatures (21 seconds, 6 trials each). Individual differences in pain-related anxiety, fear of pain, situational pain catastrophizing, depressive symptoms, and autism-related social communication were assessed by self-report. RESULTS: There were no group differences in pain thresholds. For suprathreshold tasks, mean pain ratings were higher in ASD across both the pain-rating curve and the sustained heat pain tasks, but responses in the ASD group were more varied. Pain anxiety (PASS-Total) and pain-related fear (FOP-III-Total) were higher in the ASD group and were positively associated with pain ratings. CONCLUSIONS: Our results suggest that both sensory and cognitive experiences of pain are heightened and interact reciprocally in adults with ASD. Future studies are needed to evaluate the impact of pain-related anxiety on treatment-seeking and pain behaviors, given higher levels of pain-related anxiety in ASD.

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Cited references
61
Total cited references integrated for this publication.
Cited references with an identified autistic author
1 / 61 (1.6%)
Cited author occurrences identified as autistic
1 / 284 (0.4%)
Among occurrences linked to AutiHub author records: 1 / 45 (2.2%). Distinct cited authors identified as autistic: 1 / 265 (0.4%).
Cited author occurrences linked to AutiHub author records
45 / 284 (15.8%)
Distinct linked cited authors: 31 / 265 (11.7%)
Linked cited-author occurrences not identified as autistic
44 / 45 (97.8%)
Among linked cited-author occurrences only. Across all cited-author occurrences: 44 / 284 (15.5%). Distinct linked cited authors not identified as autistic: 30 / 31 (96.8%).
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