Pain and Autism

Effective communication — a bridge to be built with Autistic patients with chronic pain

At some point in our lives, we will all experience pain – both emotional and physical.  As a result of our pain, we tend to communicate our needs for treatment very differently. But what happens when communication is impaired further by developmental disorders such as Autism? The Pain Management & Injury Relief (PMIR) team attended a lecture entitled “Pain and Autism:  Clinical Traits, Sensory Perceptions, and Practice Tips” at the 2012 PAINWeek in Las Vegas. The lecture discussed the treatment of patients with Autism with chronic pain, and the importance of reevaluating our style of communication as practitioners when treating this type of patient.

Before entering a doctor-patient relationship with a patient with Autism, it is important to understand their condition and how it relates to chronic pain. Patients with Austism aren’t always open about their pain levels, and many have difficulties with self-reporting of symptoms, illnesses, injuries, and pain. They may not want to communicate verbally either – they may want to communicate through hand signals or body gestures. Often times, children and adults with autism are hyper sensitive to what other people may see as ordinary stimuli – bright lights, colors, sounds, and their sensory interactions. It can be difficult for patients with Autism to complete goal-oriented tasks, focus on topics, and engage in higher order processing in regards to regulation and refection. When a physician seeks to understand the patient, and is open to their patient’s unique communication style, it will significantly reduce the stress and anxiety involved in the treatment process.

As discussed before, it is important for patients to provide a detailed medical history and communicate their pain experience in order for a physician to accurately assess a patient’s condition. For people with autism, communication is a bridge that needs be built and walked over many times. From the very initial contact with a patient with Autism, the physician must recognize this inherent limitation. Thus, the physician will need to find an alternate starting point from which to begin a proper diagnosis, as background must be built prior to the patient visit so that the physician can ask the right questions during the initial consultation. Below are some tips the speakers suggested when evaluating a patient with Autism with chronic pain:

1. Allow the patient to complete written information on forms before they arrive for their visit.
2. Be aware that some autistic patents may have difficulties in understanding form questions.
3. Build extra time into their consultation or follow-up to get the information you need.
4. Some patients with Autism aren’t comfortable being touched – this has to be respected for trust to be built.
5. Exams and rooms should be adapted to minimize sensory issues (e.g. music to loud, bright room lights, cold rooms).
6. Present your treatment plan with solid visuals or written words — it will significantly increase your ability to get your message to your patient.
7. Always have reference information, such as websites and brochures.
8. Plant the trust seed early –you are there to help them, establish a bonded relationship, and aid them in their chronic pain recovery.

The beauty of this lecture is that it not only applies to patients with Autism, but to all interactions we have. Autism is a lesson for all of us – a lesson of love, a lesson to slow down and be patient, a lesson to understand a fellow human being.  The result of this lecture was an evolution of understanding and compassion by our PMIR physicians and staff. As always, PMIR looks forward to sharing more stories and information about the lessons, growth, and breakthroughs our team seeks to experience in order to improve our practice.