Pain reactivity and plasma beta-endorphin in children and adolescents with autistic disorder
L. Poulain
(1, 2, 3, 4, 5)
,
P. Sujobert
(1, 2, 3, 4)
,
F. Zylbersztejn
(6, 4, 5)
,
S. Barreau
(1, 2, 3, 4, 5)
,
M. Lambert
(5, 4, 1, 3, 2)
,
V. Chesnais
(4, 5, 1, 2, 3)
,
R Birsen
(4, 5, 1, 3, 2)
,
F. Vergez
(7)
,
T. Farge
(7)
,
C. Chenevier-Gobeaux
(8)
,
M. Fraisse
(7)
,
F. Bouillaud
(4, 5, 1, 2)
,
C. Debeissat
(9)
,
O. Herault
(9)
,
C. Récher
(7)
,
C. Lacombe
(1, 5, 4, 2, 3)
,
M. Fontenay
(10, 11, 12, 1, 2, 4, 5, 3, 13)
,
P. Mayeux
(10, 11, 1, 4, 5, 2, 3)
,
T. T. Maciel
(4, 5, 6)
,
J.E. Sarry
(7)
,
J. Tamburini
(10, 11, 14, 4, 5, 1, 2, 3, 13)
,
D. Bouscary
(10, 11, 14, 1, 4, 5, 2, 3, 13)
,
N. Chapuis
(10, 11, 14, 1, 4, 5, 3, 13)
1
IC UM3 (UMR 8104 / U1016) -
Institut Cochin
2 UPD5 Médecine - Université Paris Descartes - Faculté de Médecine
3 Ligue Nationale Contre le Cancer - Paris
4 UPD5 - Université Paris Descartes - Paris 5
5 USPC - Université Sorbonne Paris Cité
6 IMAGINE - U1163 - Imagine - Institut des maladies génétiques
7 LISBP - Laboratoire d'Ingénierie des Systèmes Biologiques et des Procédés
8 CRCT - Centre de Recherches en Cancérologie de Toulouse
9 Hôpitaux Universitaires Paris Centre, Service de Diagnostic Biologique Automatisé
10 GICC UMR 6239 CNRS - Génétique, immunothérapie, chimie et cancer (GICC), UMR 6239 CNRS [2008-2011]
11 UMR_S567 / UMR 8104 - Institut Cochin
12 Equipe Labellisée
13 Hôpitaux Universitaires Paris Centre, Service d'Hématologie biologique
14 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
2 UPD5 Médecine - Université Paris Descartes - Faculté de Médecine
3 Ligue Nationale Contre le Cancer - Paris
4 UPD5 - Université Paris Descartes - Paris 5
5 USPC - Université Sorbonne Paris Cité
6 IMAGINE - U1163 - Imagine - Institut des maladies génétiques
7 LISBP - Laboratoire d'Ingénierie des Systèmes Biologiques et des Procédés
8 CRCT - Centre de Recherches en Cancérologie de Toulouse
9 Hôpitaux Universitaires Paris Centre, Service de Diagnostic Biologique Automatisé
10 GICC UMR 6239 CNRS - Génétique, immunothérapie, chimie et cancer (GICC), UMR 6239 CNRS [2008-2011]
11 UMR_S567 / UMR 8104 - Institut Cochin
12 Equipe Labellisée
13 Hôpitaux Universitaires Paris Centre, Service d'Hématologie biologique
14 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
P. Sujobert
- Fonction : Auteur
- PersonId : 774165
- ORCID : 0000-0002-9108-1162
- IdRef : 149871279
M. Fontenay
- Fonction : Auteur
J.E. Sarry
- Fonction : Auteur
- PersonId : 756167
- ORCID : 0000-0002-6704-2032
- IdRef : 067411673
J. Tamburini
- Fonction : Auteur
D. Bouscary
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- Fonction : Auteur correspondant
- PersonId : 1037060
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N. Chapuis
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- Fonction : Auteur correspondant
- PersonId : 1037061
Connectez-vous pour contacter l'auteur
Résumé
Background: Reports of reduced pain sensitivity in autism have prompted opioid theories of autism and have practical care ramifications. Our objective was to examine behavioral and physiological pain responses, plasma β-endorphin levels and their relationship in a large group of individuals with autism.
Methodology/Principal Findings: The study was conducted on 73 children and adolescents with autism and 115 normal individuals matched for age, sex and pubertal stage. Behavioral pain reactivity of individuals with autism was assessed in three observational situations (parents at home, two caregivers at day-care, a nurse and child psychiatrist during blood drawing), and compared to controls during venepuncture. Plasma β-endorphin concentrations were measured by radioimmunoassay. A high proportion of individuals with autism displayed absent or reduced behavioral pain reactivity at home (68.6%), at day-care (34.2%) and during venepuncture (55.6%). Despite their high rate of absent behavioral pain reactivity during venepuncture (41.3 vs. 8.7% of controls, P<0.0001), individuals with autism displayed a significantly increased heart rate in response to venepuncture (P<0.05). Moreover, this response (Δ heart rate) was significantly greater than for controls (mean±SEM; 6.4±2.5 vs. 1.3±0.8 beats/min, P<0.05). Plasma β-endorphin levels were higher in the autistic group (P<0.001) and were positively associated with autism severity (P<0.001) and heart rate before or after venepuncture (P<0.05), but not with behavioral pain reactivity.
Conclusions/Significance: The greater heart rate response to venepuncture and the elevated plasma β-endorphin found in individuals with autism reflect enhanced physiological and biological stress responses that are dissociated from observable emotional and behavioral reactions. The results suggest strongly that prior reports of reduced pain sensitivity in autism are related to a different mode of pain expression rather than to an insensitivity or endogenous analgesia, and do not support opioid theories of autism. Clinical care practice and hypotheses regarding underlying mechanisms need to assume that children with autism are sensitive to pain.
