Autism spectrum disorder in the children of chronic pain patients.
Research type
Research Study
Full title
Autism spectrum disorder in the children of patients suffering from chronic pain.
IRAS ID
331233
Contact name
Allegra Hirst
Contact email
Sponsor organisation
The Walton Centre
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Summary of Research
Chronic pain is a common health condition, and although the mechanisms underpinning chronic pain are often unclear, there is growing evidence that the primary chronic pain conditions fibromyalgia syndrome (FMS) and complex regional pain syndrome (CRPS) have an autoimmune component. Autoantibodies have gained attention as a potential pathogenic role in persistent pain states; in persistent complex regional pain syndrome and fibromyalgia syndrome passive transfer of Immunoglobin G (IgG) antibodies from patient-donors cause symptoms to rodents that closely resemble those of the clinical disorders (Cuhudar et al., 2019; Goebel et al., 2021).Independent of this, there is also growing interest in the role of the prenatal immune environment in the development of ASD in children. Previous retrospective research has demonstrated an increased likelihood of ASD in the children of mothers with any autoimmune disease (Chen et al. 2016; Kiel et al. 2010). Moreover, animal models have implicated IgG antibodies in the behavioural and cognitive features that characterise ASD. No specific causal factors have been identified, but it is theorized that the presence of pathologically significant maternal autoantibodies might affect foetal development during pregnancy.
The current study team conducted a service evaluation to record the frequency of reported neurodivergent children amongst a sample of chronic pain patients from the Walton Centre. This displayed an increased prevalence of ASD in the children of parents with a specific primary chronic pain condition, including FMS and CRPS. The present study will invite this same sample of chronic pain patients to prospectively investigate what factors underlie this increased prevalence. The sample will consist of all new patients from Prof A. Goebel’s pain outpatient clinics at the Walton Centre. This novel study could provide important insights into the risk factors associated with the development of ASD in the children of a sample population of chronic pain patients.
Summary of Results
The study titled “Autism spectrum disorder in the children of patients suffering from chronic pain” was sponsored by The Walton Centre NHS Foundation Trust. There was no funding, and Prof. A. Goebel declares consultancy to UCB. Following clinical observations of fibromyalgia patients frequently reporting having autistic children, 589 patients who attended one consultant’s pain outpatient clinic were invited to take part in an online questionnaire to explore the occurrence of autism in children. Chronic pain patients involved in an existing Patient and Public Involvement group at our research institution advised on the content of the survey, its clarity, and sensitivity. In addition to prevalence, we also measured and recorded a family history of neurodivergence, autistic traits in chronic pain patients and all children, the development of the pain phenotype in patients and how this relates to the timing of pregnancies, and further information regarding children with autism, including level of support needs, co-occurring conditions, and birth/pregnancy complications. The aim of the study was to compare the prevalence of autistic children across chronic pain conditions and to see what maternal factors may be associated with autism in children. Sixty-six total patients participated in the study (29 fibromyalgia, 11 complex regional pain syndrome, and 26 other chronic pain conditions). The results of the study showed an increased prevalence of autism in the children of fibromyalgia patients compared to patients with other types of chronic pain (e.g., back pain). This relationship was statistically significant, with mothers with fibromyalgia showing an increased likelihood of autistic children compared to mothers with other chronic pain conditions. Moreover, a first-degree family history of neurodivergent conditions was associated with autism in children. This is the first study to demonstrate this relationship, and it is thought that this new knowledge may be a valuable addition to the clinical routine. Caring and advocating for an autistic child can place additional demands on the parent, which may be particularly challenging for people suffering from severe chronic pain. The knowledge of this association between fibromyalgia in mothers and autism in children can help pain practitioners further understand the patient’s life and home situation and gather information to gauge support requirements.REC name
Wales REC 2
REC reference
24/WA/0056
Date of REC Opinion
3 Apr 2024
REC opinion
Further Information Favourable Opinion