As far as I know the controversy is or was between a higher pain threshold, so less pain experience on one hand or a different expression of the same pain felt by non-autistic people. Nader et al. (2004) and Tordjman et al. (2009) are in favor of the latter and have done empirical research to support this. Yet, from clinical practice the anecdotes about – especially autistic children – apparently being oblivious to pain, are abundant. The latter is reflected in the DSM-IV and DSM-IV-TR which mention “a high threshold for pain”.
The DSM5, which replaced the DSM IV refers to "apparent indifference to pain" as an example of the over or under-reactivity to sensory stimuli that MAY occur in SOME children with autism. It is certainly true that some individuals with autism engage in self-injury with APPARENT disregard for pain. However, APPARENT DISREGARD does not mean that they do not experience pain and physiological responses to pain such as changes in heart rate and stress chemicals in individuals with autism generally appear normal as reported by several researchers.
Thanks Dick. Indeed a possible discrepancy between measurable physiological responses and the necessarily subjective experience of pain, seems to be the core of the matter. I don't know enough of this subject matter to say anything sensible about it. I hope some experts in pain do, in principle, regardless of autism.
I think there is a strong parallel with the history of the way pain was viewed in neonates. For many decades, well-meaning people published the myth that infants were relatively insensitive to pain and therefore there was little reason to consider their pain in decisions like whether to use anesthetics. When careful attention was given to physiological indicators of pain, however, it became apparent that they do experience pain but didn't always express it as we expected. With this information, it became harder to pretend that they did not feel pain or disregard the pain they experienced.
Hi Flip, that's an interesting question and although I don't have a solid insight, my opinion is that a high nociceptive threshold can certainly fit with the "Opioid Excess" theory in autism (quick link below), since an excess in endogenous opioids could in theory contribute to a form of "endgogenic analgesic tolerance", manifested as an increase in pain threshold. So, the biochemical data seem to fit with the theory, but not sure if this is (has been) backed up by electrophysiology.
http://www.de-poort.be/cgi-bin/Document.pl?id=52
Thanks Nikolas. So far my tally is 1 nay and 1 aye. Did you forget to add the link or did it disappear in the process?
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