ISSN 0439-755X
CN 11-1911/B
主办:中国心理学会
   中国科学院心理研究所
出版:科学出版社

心理学报 ›› 2021, Vol. 53 ›› Issue (6): 613-628.doi: 10.3724/SP.J.1041.2021.00613

• 研究报告 • 上一篇    下一篇

自闭症谱系障碍个体的疼痛敏感性异常:来自元分析的证据

张文芸, 李晓云, 姚俊杰, 叶倩, 彭微微()   

  1. 深圳大学心理学院, 深圳 518060
  • 收稿日期:2020-09-21 发布日期:2021-04-25
  • 通讯作者: 彭微微 E-mail:ww.peng0923@gmail.com
  • 基金资助:
    国家自然科学基金(31871127);广东省普通高校特色创新类项目(2019KTSCX149);深圳市基础研究自由探索项目(JCYJ20190808154413592)

Abnormalities in pain sensitivity among individuals with autism spectrum disorder: Evidence from meta-analysis

ZHANG Wenyun, LI Xiaoyun, YAO Junjie, YE Qian, PENG Weiwei()   

  1. School of Psychology, Shenzhen University, Shenzhen 518060, China
  • Received:2020-09-21 Published:2021-04-25
  • Contact: PENG Weiwei E-mail:ww.peng0923@gmail.com

摘要:

本研究采用元分析方法, 以疼痛阈限、疼痛诱发生理反应和疼痛评分为结果变量, 考察了自闭症谱系障碍个体(Autism Spectrum Disorder, ASD)的疼痛敏感性异常, 以期为ASD的诊断和干预提供参考。元分析共纳入16项研究(总样本量N = 822)。对于疼痛阈限, ASD组和对照组无显著差异, 但受到疼痛模态等变量的调节作用, 如ASD组的压力疼痛阈限显著低于对照组。对于疼痛诱发生理反应, ASD组对现实医疗疼痛的生理反应强于对照组。然而, ASD组和对照组在疼痛评分上无显著差异。将来研究应结合多模态疼痛刺激和多维度疼痛评估, 系统考察ASD个体的疼痛敏感性及其与临床核心症状之间的联系。

关键词: 自闭症谱系障碍, 疼痛敏感性, 元分析, 疼痛阈限, 疼痛诱发生理反应

Abstract:

Pain is defined as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Pain is of vital functional significance, as it signals threat and initiates behavioral adaptations to avoid harm so as to protect the body. Previous studies have shown abnormalities in pain sensitivity among individuals with autism spectrum disorder (ASD), which have been associated with their clinical core symptoms, including restricted and repetitive behaviors as well as deficits in social behaviors. Evidence from case studies and surveys suggested the hyposensitivity to pain for individuals with ASD. Nevertheless, results from experimental studies that involved the application of noxious stimulations and psychophysical measurements were heterogeneous, e.g., some studies reported hypersensitivity to pain in ASD individuals, others reported their hyposensitivity or even normal sensitivity to pain.

These results suggest that the abnormalities of pain sensitivity among individuals with ASD were modality-dependent, with the abnormality selectively applicable to pressure pain or medical pain. Future studies should combine behavioral, physiological, and neuroimaging measures to comprehensively investigate the pain sensitivity profiles of individuals with ASD. The potential link between pain sensitivity and clinical core symptoms among individuals with ASD should be characterized. Relevant results would potentially expand our understanding of ASD neurobiological mechanisms and provide the theoretical basis for pain assessment among individuals with ASD.

In this study, we utilized a meta-analysis approach to systematically review experimental studies that investigated pain sensitivity among individuals with ASD and were published before August 10, 2020. The meta-analysis was performed according to the rigorous PRISMA Protocol. Studies were included in the analysis if they included both clearly diagnosed ASD individuals and healthy controls, reported data relevant to pain sensitivity, including pain threshold, pain tolerance, pain ratings, and pain-evoked physiological responses. Relevant studies were obtained from databases including China National Knowledge Infrastructure, Web of Science, PsycInfo, and PubMed by searching for keywords including pain, nociception, autis*, and Asperger. The meta-analysis was conducted in STATA 12, and the effect sizeHedge's g with ±95% confidence intervals (CIs) was calculated using a random effect statistical model. Further, we assessed possible moderating effects from variables of pain modality, pain site, the age of involved participants, the sample size of the ASD group and sample locations.

Sixteen experimental studies were included in the meta-analysis, with a total sample size N = 822. Pain threshold was not significantly different between ASD individuals and healthy controls (g = 0.34, 95% CI = [-0.14, 0.82]), and this estimate was moderated by variables of pain modality, the age of involved participants, and the sample size of the ASD group. Specifically, individuals with ASD exhibited lower pain thresholds than those of healthy controls selectively for pressure pain (g = 1.62, 95% CI = [0.46, 2.77]). For the outcome variable of pain evoked physiological response, individuals with ASD showed significantly greater physiological responses to medical procedures than those of healthy controls (g= 2.87, 95% CI = [1.07, 4.67]). Nevertheless, ASD and control groups had comparable pain ratings (g = -0.26, 95% CI = [-0.64, 0.11]).

Key words: autism spectrum disorder, pain sensitivity, meta-analysis, pain threshold, pain-evoked physiological response

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