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Pain Processing in Psychiatric Conditions: A systematic reviewObjective: Pain is a universal, multidimensional experience with sensory emotional, cognitive and social components, which is fundamental to our environmental learning when functioning typically. Understanding pain processing in psychiatric conditions could provide unique insight into the underlying pathophysiology or psychiatric disease, especially given the psychobiological overlap with pain processing pathways. Studying pain in psychiatric conditions is likely to provide important insights, yet, there is a limited understanding beyond the work outside depression and anxiety. This is a missed opportunity to describe psychiatric conditions in terms of neurobiological alterations. In order to examine the research into the pain experiences of these groups and the extent to which a-typicality is present, a systematic review was conducted. Methods: An electronic search strategy was developed and conducted in several databases. Results: The current systematic review included 46 studies covering five DSM-5 disorders: autism, attention deficit hyperactivity disorder, schizophrenia, personality disorder and eating disorders, confirming tentative evidence of altered pain and touch processing. Specifically, hyposensitivity is reported in schizophrenia, personality disorder and eating disorder, hypersensitivity in ADHD and mixed results for autism. Conclusions: Review of the research highlights a degree of methodological inconsistency in the utilisation of comprehensive protocols; the lack of which fails to allow us to understand whether a-typicality is systemic or modality-specific.
A Quantitative Sensory Testing Approach to Pain in Autism Spectrum DisordersSensory abnormalities in autism has been noted clinically, with pain insensitivity as a specified diagnostic criterion. However, there is limited research using psychophysically robust techniques. Thirteen adults with ASD and 13 matched controls completed an established Quantitative Sensory Testing (QST) battery, supplemented with measures of pain tolerance and central modulation. The ASD group showed higher thresholds for light touch detection and mechanical pain. Notably, the ASD group had a greater range of extreme scores (the number of z-scores outside of the 95% CI >2), dynamic mechanical allodynia and paradoxical heat sensation; phenomena not typically seen in neurotypical individuals. These data support the need for research examining central mechanisms for pain in ASD and greater consideration of individual difference.