ABSTRACT
Pain assessments typically depend on self-report of the pain experience. Yet, in individuals with autism spectrum disorders, this can be an unreliable due to communication difficulties. Importantly, observations of behavioral hypo- and hyperresponsivity to pain suggest altered pain sensitivity in autism spectrum disorder. Neuroimaging may provide insight into mechanisms underlying pain behaviors. The neural pain signature reliably responds to painful stimulation and is modulated by other outside regions, affecting the pain experience. In this first functional magnetic resonance imaging study of pain in autism spectrum disorder, we investigated neural responses to pain in 15 adults with autism spectrum disorder relative to a typical comparison group (n = 16). We explored temporal and spatial properties of the neural pain signature and its modulators during sustained heat pain. The two groups had indistinguishable pain ratings and neural pain signature responses during acute pain; yet, we observed strikingly reduced neural pain signature response in autism spectrum disorder during sustained pain and after stimulus offset. The posterior cingulate cortex, a neural pain signature modulating region, mirrored this late signal reduction in autism spectrum disorder. Intact early responses, followed by diminished late responses to sustained pain, may reflect altered pain coping or evaluation in autism spectrum disorder. Evidence of a dichotomous neural response to initial versus protracted pain may clarify the coexistence of both hypo- and hyperresponsiveness to pain in autism spectrum disorder.
Subject(s)
Autism Spectrum Disorder/diagnostic imaging , Brain/diagnostic imaging , Hyperesthesia/diagnostic imaging , Hypesthesia/diagnostic imaging , Pain/diagnostic imaging , Adolescent , Adult , Autism Spectrum Disorder/epidemiology , Autism Spectrum Disorder/physiopathology , Brain/physiopathology , Case-Control Studies , Female , Functional Neuroimaging , Gyrus Cinguli/diagnostic imaging , Gyrus Cinguli/physiopathology , Hot Temperature , Humans , Hyperesthesia/physiopathology , Hypesthesia/physiopathology , Magnetic Resonance Imaging , Male , Pain/physiopathology , Pain Perception , Pain Threshold , Self-Injurious Behavior/epidemiology , Young AdultABSTRACT
Clinical-radiologic correlations in 27 patients with pure sensory strokes (PSS) were retrospectively studied. Dysesthesias from pontine lesions were more severe than those from thalamic lesions. Pontine PSS but not thalamic PSS selectively affected vibration and position sense, leaving pinprick and temperature perceptions intact. Thalamic lesions but not pontine tended to spare the trunk.
