Pain Perception in Autism Spectrum Disorders

Pain perception in autism spectrum disorders (ASD) presents a complex and heterogeneous profile that challenges traditional notions of uniform hyposensitivity or hypersensitivity. Individuals with ASD may exhibit atypical responses across the pain cycle—from peripheral transduction and central transmission to cognitive appraisal and modulation—resulting in varied expression and reporting of discomfort. Neurophysiological studies point to interplay between altered sensory thresholds, neural network differences and perceptual variability, while behavioural research highlights the role of emotion regulation and coping strategies. These dimensions combine to produce divergent clinical presentations: some children and adults appear oversensitive, reacting intensely to innocuous stimuli, whereas others show minimal behavioural indicators despite physiological signs of distress. Diagnostic overshadowing and communication barriers further obscure accurate pain assessment, with practical implications for clinical care, educational support and quality of life. A global research effort seeks to delineate underlying mechanisms, improve measurement paradigms and develop targeted interventions—from sensory rehabilitation to psychopharmacological modulation—that acknowledge both peripheral and central contributions to the pain experience in ASD.

Research from Nature Portfolio

Recent psychophysical work has refined understanding of basic thermal perception in ASD. A large-scale study employing method-of-limits protocols measured warm and cool detection thresholds in a cohort spanning childhood to adulthood and found no systematic elevation of baseline thresholds in autistic participants compared with controls. Instead, intra-individual trial-to-trial variability emerged as the dominant predictor of apparent sensory differences, alongside factors such as performance IQ and sex. These findings suggest that perceptual noise rather than a uniform shift in sensory sensitivity may underpin reports of atypical temperature and pain reactivity in ASD, and they underscore the need to consider cognitive and demographic moderators when interpreting psychophysical data.

Pain Perception in Autism Spectrum Disorders publication trend

The graph below shows the total number of articles in pain perception in autism spectrum disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Central sensitisation: An increased excitability of central neurons leading to amplification of sensory input and pain perception.

Somatosensory threshold: The minimum intensity of a mechanical, thermal or nociceptive stimulus required for detection.

Quantitative sensory testing (QST): A battery of psychophysical methods to assess detection and pain thresholds and central pain modulation.

Intra-individual variability: Fluctuations in perceptual or behavioural responses across repeated trials within the same individual.

References

1. Central Sensitivity Symptoms and Autistic Traits in Autistic and Non‐Autistic Adults. Autism Research (2025).
2. A multidimensional investigation of the relationship between skin-mediated somatosensory signals, emotion regulation and behavior problems in autistic children. Frontiers in Neuroscience (2023).
3. The Current View on the Paradox of Pain in Autism Spectrum Disorders. Frontiers in Psychiatry (2022).
4. Thermal Perceptual Thresholds are typical in Autism Spectrum Disorder but Strongly Related to Intra-individual Response Variability. Scientific Reports (2019).