Chronic pain is a common cause of disability within our society. A recent study from the 2012 National Health Interview Survey found that approximately 11% or 25 million adults in America experience chronic pain (note: “chronic” being defined as pain every day for the 3 months preceding the survey). Compounding the problem, those individuals with chronic pain also had worse health status and a confluence of multiple symptoms, e.g., individuals with low back pain have a higher prevalence of other pain conditions such as episodic headaches.
Men and women differ in regards to their sensitivity to pain and response to pharmacological and non-pharmacological interventions (Bartley and Fillingim, 2013). In some cases, use of certain medications (e.g., ergotamines, tryptans) for prolonged periods of time may exacerbate and prolong the pain. In addition, pain perception is modified by sociodemographic features like self-perceived health status, lifestyle habits, and psychological distress. Autistic individuals may be predisposed to chronic pain. Studies indicate a higher risk of autism among children of Rh negative mothers. Indeed, rhesus negative individuals report a higher incidence of health disorders including more frequent allergic, digestive, heart, hematological, immunity, mental health, and neurological problems (Flegr et al., 2015).
A descriptive article in Spectrum described chronic pain in autism as an “unseen agony”. While autistic individuals can exhibit tolerance to extreme environmental conditions they can also experience intense pain and struggle to communicate the same. In previous blogs I have commented on how sleep and anxiety disturbances may compound their pain and how they may face difficulties in expressing their symptoms because of an inate abnormality in sensory perception.
One common cause of chronic pain in autism appears to be irritable bowel syndrome. This is a common disorder that affects the large intestine causing abdominal pain, bloating, diarrhea and/or constipation (see previous blog on antibiotics and the microbiome ). The symptoms severely restrict partaking in social activities. Individuals who receive antibiotics during their first year of life appear to be at a higher risk for developing irritable bowel syndrome as adults. Celiac disease is another gastrointestinal disorder that appears to affect many autistic individuals (note: large studies attempting to establish a correlation between celiac disorder and autism have yielded contradictory results, see Ludvigsson et al., 2013). Celiac disease is a severe autoimmune disorder that affects 1% of the general population worldwide. It is seen as a reaction to gluten (a mixture of proteins found in wheat, rye, and barley) in the diet. Many people who feel relief by a gluten free diet may not be doing so because of their response to gluten but because of their reaction to fermentable carbohydrates. These carbohydrates are known by the acronym FODMAPs which stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. They can also be sensitive to amylase trypsin inhibitors, a natural pesticide, which occurs in wheat grains. Amylase trypsin inhibitors drive intestinal inflammation and activate aspects of the innate immune response. My own personal opinion is that if you find relief or improvement with a gluten free diet, you should continue the same regardless of whether we know or not the cause for the improvement.
In my next blog I will speak about causes of chronic pain in a particular subtype of patients with autism: individuals exhibiting joint hypermotility including those having comorbid Ehlers-Danlos or Marfan Syndrome.
Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 111(1):52-58, 2013.
Flegr J, Hoffman R, Dammann M. Worse health status and higher incidence of health disorders in rhesus negative subjects. PLOS One (2015)· https://doi.org/10.1371/journal.pone.0141362
Ludvigsson JF, Reichenberg A, Hultman CM, et al., A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders. JAMA 70(11):1224-1230, 2013.