Autism and Chronic Pain: Is There a Connection?

adminaspect
2 days ago
8 min read

When we think about autism, we often think about differences in communication, social interaction, sensory processing and routines. However, autism can also intersect with physical health in ways that are less widely recognised.

One area receiving increasing research attention is chronic pain.

Research suggests that autistic people may experience chronic pain and certain pain-related conditions at higher rates than previously recognised. These can include headaches and migraine, abdominal and gastrointestinal pain, musculoskeletal pain and conditions such as fibromyalgia.

So, why might autism and chronic pain be connected?

Chronic Pain in Autistic People

Chronic pain is generally defined as pain that persists or recurs for longer than three months. It can occur in one part of the body or affect several areas and can have a significant impact on sleep, energy levels, mental wellbeing and everyday life.

A 2025 systematic review published in The Clinical Journal of Pain examined the existing research into chronic pain in autistic people.

Researchers reviewed 26 studies covering the prevalence, assessment and treatment of chronic pain in autism. Chronic abdominal pain and headaches were among the most frequently studied problems.

Importantly, the researchers also highlighted significant gaps in our understanding of autistic people's experiences of pain. Many studies relied on parents, professionals or researchers to assess pain rather than asking autistic people themselves.

Only one of the studies examining pain assessment relied on self-reported measures. This matters because autistic people may experience, recognise and communicate pain differently.

Autism Can Affect How Pain Is Experienced

Autistic sensory differences can involve much more than sensitivity to noise, light, textures or smells.

The nervous system also processes information coming from within the body.

This is known as interoception.

Interoception helps us recognise internal sensations such as hunger, thirst, temperature, a racing heartbeat, needing the toilet and pain.

Some autistic people experience differences in interoception. This can make it more difficult to recognise what is happening within the body or determine exactly where an uncomfortable sensation is coming from.

At the same time, autistic people can experience heightened sensitivity to particular sensations.

This means there isn't one universal "autistic response" to pain.

One autistic person may be extremely sensitive to certain painful sensations, while another may not recognise an injury or illness immediately. The same individual may also be highly sensitive to one type of pain while appearing relatively insensitive to another.

Research involving autistic adults has highlighted the importance of pain awareness and communication. Autistic participants have described pain affecting not only their physical wellbeing but their ability to function, participate in everyday activities and manage other sensory information.

This challenges the outdated assumption that autistic people simply have a "high pain threshold".

The reality is much more complex.

What About Fibromyalgia?

Fibromyalgia is a long-term condition characterised by widespread pain and tenderness. It can also involve fatigue, sleep difficulties, cognitive problems and increased sensitivity to sensory stimuli.

This is particularly interesting in relation to autism because fibromyalgia is associated with changes in the way the nervous system processes pain.

One concept researchers have investigated is central sensitisation.

Central sensitisation describes increased responsiveness within the central nervous system. Essentially, the nervous system can become increasingly sensitive to sensory information, including pain.

This can contribute to:

Hyperalgesia – experiencing painful stimuli more intensely than expected.
Allodynia – experiencing pain from stimuli that would not normally be painful, such as light touch.

Researchers are now investigating whether sensory processing differences associated with autism could overlap with some of the mechanisms involved in central sensitisation.

A 2025 study involving 534 autistic and non-autistic adults examined conditions known as central sensitivity syndromes. These include conditions associated with chronic pain, fatigue and sensory sensitivity, such as fibromyalgia and migraine.

Interestingly, autistic participants without a diagnosed central sensitivity syndrome still reported significantly more central sensitivity symptoms than the comparison group.

The researchers also found sensory sensitivity, anxiety and autistic traits were associated with central sensitivity symptoms.

However, this does not mean autism causes fibromyalgia or that fibromyalgia is simply another manifestation of autism.

Instead, it suggests that there may be overlapping biological and sensory mechanisms worthy of further investigation.

A Recent Study Specifically Looked at Fibromyalgia and Autistic Traits

Research published in 2025 examined 260 people diagnosed with fibromyalgia alongside 139 people from the general population.

The researchers measured sensory processing sensitivity, central sensitisation symptoms and autistic traits.

Participants with fibromyalgia reported higher levels across all three areas, and the researchers found significant relationships between sensory sensitivity, central sensitisation symptoms and autistic traits.

The authors suggested that autism may potentially be more prevalent among some people with fibromyalgia, particularly those experiencing very high levels of central sensitisation symptoms.

However, they also raised an important caution.

Symptoms associated with central sensitisation could potentially increase scores on questionnaires measuring autistic traits. This means clinicians should be careful not to assume that someone is autistic simply because they have fibromyalgia and sensory sensitivities.

This is an emerging area of research, and much more investigation is needed before we fully understand the relationship.

Hypermobility May Be Another Piece of the Puzzle

There is another fascinating connection between autism and chronic pain: joint hypermobility.

Joint hypermobility means that some or many joints move beyond the range normally expected.

For some people this causes few problems. For others, symptomatic hypermobility can be associated with joint and muscle pain, fatigue, recurrent injuries, difficulties with proprioception and symptoms of autonomic dysfunction.

Research has found an association between autism and symptomatic generalised joint hypermobility.

One adult study found symptomatic generalised joint hypermobility in 16.7% of autistic participants compared with 4.8% of controls. After adjusting for factors including age and sex, autism was associated with substantially increased odds of symptomatic hypermobility.

Other research involving neurodivergent adults has found strong relationships between hypermobility, autonomic symptoms and musculoskeletal pain.

This provides another possible route through which some autistic people may be particularly vulnerable to persistent pain.

Again, however, this does not mean that all autistic people are hypermobile or that all hypermobile people are autistic.

Chronic Pain May Be Particularly Important for Autistic Women

Some research has highlighted particularly high levels of chronic pain among autistic and ADHD women.

A longitudinal study involving women with autism and/or ADHD found that 76.6% reported chronic pain.

Those experiencing chronic pain also reported poorer health-related quality of life.

There are limitations to studies like this, and the findings should not be interpreted as meaning that three-quarters of all autistic women experience chronic pain. Nevertheless, the results reinforce the importance of taking physical pain seriously when supporting autistic women.

Historically, autistic women have also been particularly vulnerable to late or missed autism diagnoses. This raises another important question: could some people attending healthcare services for chronic pain, fatigue, migraine or fibromyalgia also have unidentified autism?

Research is beginning to explore this possibility.

Pain Can Also Increase Autistic Overwhelm

There is another side to this relationship.

It isn't only about whether autistic people are more likely to experience pain. Pain itself can make autistic experiences more difficult to manage.

Imagine already processing noise, lighting, movement, social information and internal bodily sensations differently, while simultaneously experiencing persistent pain.

Your capacity for additional sensory information may become much smaller.

Research interviewing autistic adults about their experiences of pain found that pain could affect daily functioning and participation considerably.

For some autistic people, chronic pain may therefore contribute to:

increased sensory sensitivity
difficulty concentrating
greater fatigue
disrupted sleep
reduced ability to communicate
increased need for routine and predictability
greater difficulty coping with unexpected demands
increased shutdowns or overwhelm.

Behaviour that appears to be "challenging", withdrawn or unusually distressed may sometimes be communicating something much simpler:

This person is in pain.

Why Pain Can Sometimes Be Missed in Autistic People

Recognising pain in autistic people can be complicated.

An autistic person may:

struggle to identify or locate the sensation
describe pain differently from expected
have difficulty translating physical sensations into words
communicate distress behaviourally rather than verbally
appear unusually calm despite significant pain
experience several uncomfortable sensory signals simultaneously
not realise that a sensation represents pain or illness
have difficulty answering broad questions such as "How are you feeling?"

For autistic people with learning disabilities or limited spoken communication, recognising pain may present additional challenges.

Families, carers and healthcare professionals may therefore need to pay attention to changes in behaviour, sleep, appetite, movement, sensory tolerance and everyday routines.

A sudden change in behaviour should not automatically be attributed to autism.

Physical discomfort and pain should always be considered.

What Does the Research Tell Us So Far?

The emerging picture is fascinating, but we need to be careful not to oversimplify it.

There is evidence connecting autism with chronic pain, sensory processing differences, central sensitivity symptoms and joint hypermobility.

There is also emerging evidence of an overlap between autistic traits and fibromyalgia.

However, researchers have not established that autism causes fibromyalgia or chronic pain.

Instead, several potentially overlapping factors are being investigated, including:

sensory processing differences
interoceptive differences
central sensitisation
joint hypermobility
autonomic nervous system differences
sleep disturbance
migraine
gastrointestinal conditions
anxiety and stress
differences in recognising and communicating pain.

It may eventually turn out that several different mechanisms contribute to the association rather than there being one simple explanation.

Why Awareness Matters

Understanding the relationship between autism and pain isn't simply an interesting area of research.

It has practical implications.

If healthcare professionals assume that autistic people experience or communicate pain in the same way as everybody else, important physical health problems could potentially be overlooked.

Equally, symptoms such as exhaustion, withdrawal, reduced communication or increased sensory distress shouldn't automatically be attributed to autism when an underlying physical condition could be contributing.

For autistic people themselves, understanding their own sensory and interoceptive differences may also make it easier to recognise patterns and communicate their healthcare needs.

Most importantly, pain experienced by an autistic person is still pain.

It deserves to be recognised, investigated and treated appropriately.

Final Thoughts

Our understanding of autism continues to develop.

Increasingly, research is showing us that autism cannot be understood solely through behaviour, communication and social interaction. We also need to understand how autistic people experience their bodies, sensory environments and physical health.

Chronic pain is an important part of that conversation.

Research into fibromyalgia, central sensitisation, hypermobility and autism is still developing, and many questions remain unanswered. However, the emerging evidence gives us another reason to listen carefully to autistic people's descriptions of their bodies and experiences rather than assuming what pain "should" look like.

At Aspect Autism, we believe that understanding autism means understanding the whole person.

We provide comprehensive autism assessments for children and adults, alongside post-diagnostic support designed to help autistic individuals and their families better understand their experiences, needs and strengths.

If you think that you or someone you care for may be autistic, or you would like support following an autism diagnosis, please contact Aspect Autism to find out more about how we can help.