Systematic review of autistic representation in the treatment literature for pediatric chronic pain

Boerner, KE ORCID: 0000-0003-1652-4813, Pawliuk, C ORCID: 0000-0001-7507-8759, Heran, A, Donaghy, B ORCID: 0000-0003-2695-8105, Moore, D ORCID: 0000-0002-5228-3124, Leong, K, Devan, H and Oberlander, TF (2025) Systematic review of autistic representation in the treatment literature for pediatric chronic pain. The Journal of Pain. ISSN 1526-5900

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Abstract

Chronic pain disproportionately affects autistic children and young people, yet they are underrepresented in pain research. Research on psychological, physical, and pharmacological therapies for other conditions suggests modifications are required to ensure treatment accessibility and efficacy for autistic individuals. However, no such evidence base has been synthesized in pediatric pain. The aim of this review was to (1) review existing "gold-standard" treatment literature for pediatric chronic pain to determine the representation of autistic participants, and (2) review literature on treatment of chronic pain specifically in autistic children and young people to describe the current evidence landscape and identify next directions for research. 16.7% (12/72) of randomized controlled trials included in Cochrane reviews of interventions for pediatric chronic pain explicitly excluded youth with a developmental delay/disability, of which only 8.3% specifically named autism. However, 52.8% of Cochrane-included trials had criteria or protocols which may have disproportionately impacted autistic participants, such as excluding intellectual disability, psychiatric conditions, medical conditions, and/or requiring participants to communicate verbally. Twenty-nine studies of treating chronic pain in autistic children and young people were identified, of which the majority were case reports (k = 27, 93%) with large variation in pain condition, intervention applied, and outcomes measured. Given the high prevalence of chronic pain in autistic children and young people, there is an ethical imperative to ensure their representation in intervention trials, co-develop interventions that address the specific needs of autistic individuals who live with pediatric chronic pain, and to increase accessibility in chronic pain research more broadly.

Item Type:	Article
Uncontrolled Keywords:	Autism; Chronic pain; Pediatrics; Systematic review; Therapeutics; 4201 Allied Health and Rehabilitation Science; 32 Biomedical and Clinical Sciences; 3202 Clinical Sciences; 42 Health Sciences; Mental Health; Neurosciences; Clinical Research; Clinical Trials and Supportive Activities; Chronic Pain; Behavioral and Social Science; Pain Research; Brain Disorders; Intellectual and Developmental Disabilities (IDD); Pediatric; Autism; 7.1 Individual care needs; 6.1 Pharmaceuticals; 6.6 Psychological and behavioural; Mental health; Neurological; 11 Medical and Health Sciences; 17 Psychology and Cognitive Sciences; Anesthesiology; 3202 Clinical sciences; 4202 Epidemiology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
Publisher:	Elsevier
Date of acceptance:	3 April 2025
Date of first compliant Open Access:	1 September 2025
Date Deposited:	01 Sep 2025 11:19
Last Modified:	01 Sep 2025 11:30
DOI or ID number:	10.1016/j.jpain.2025.105390
URI:	https://researchonline.ljmu.ac.uk/id/eprint/27044

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