Tuesday, September 20th
10:45am-12:15pm EDT


Topical Workshop


Pain in Special Populations


717 A/B

Pain in People with Intellectual and Developmental Disabilities Across the Life Span: Where Do We Go from Here?

Children and adults living with intellectual and/or developmental disabilities (IDD) are at high risk of pain. The identification and assessment of pain are especially challenging among individuals with IDD whose communication abilities may be limited or absent. Treating pain is also challenging because there is limited evidence on pain management practices for individuals with IDD. Recently, projects specific to improving pain practices for adults with IDD have been emerging, implementing multidimensional approaches and the use of various techniques as well as monitoring responses to medications. The workshop will provide a state of the science overview regarding the risks of pain and relevant pain assessment methods for individuals with IDD across the life span, and will introduce new, practical management programs. The presenters are members of a new IASP special interest group named “Pain in Individuals with Intellectual and Developmental Disabilities (SIGPIDD)”, launched at the conference, and the missions and aims of the new SIG will be introduced. Following the experts' presentations members of the audience will be encouraged to share the challenges they experience while studying or treating people with IDD, and an open discussion is planed regarding the implementation of the presented new treatment methods.


10:45am EDT12:15pm EDT

Pain Management in Individuals With Intellectual Disabilities

Tracks: Pain In Special Populations
Categories: Topical Workshop

Individuals with intellectual disabilities are more at risk for various causes of pain, associated with their congenital anomalies such as cardiac defects, but also later in life with dental problems and gastroesophageal reflux disease. General recommendations to develop a pain treatment strategy will be shared, especially since it is known that physicians tend to prescribe sub-therapeutic doses of analgesics to individuals with intellectual disabilities. Attention should be given to multimodal interventions, which includes pharmacological and non-pharmacological treatments. Epilepsy is a common comorbidity in intellectual disability and the drug-drug interactions will be discussed. Results from pharmacokinetic and pharmacodynamic studies on pain management in intellectually disabled individuals will be presented.
Given the complexity of pain in the intellectual disability population, effective pain management requires a multidimensional approach and continuous reassessment to ensure a focus on quality of life indicators and not just reduction of pain. In addition, relevant individuals such as family/caregivers and the individual with intellectual disability themselves should be included in the assessment, management, and evaluation.

10:45am EDT12:15pm EDT

Pain in Intellectual and Development Disability: Scope of The Problem

Tracks: Pain In Special Populations
Categories: Topical Workshop
Presented By: Professor Ruth Defrin

The study of pain among people with intellectual and developmental disabilities (IDD) has not yet gained the sufficient attention it deserves and therefore it is important to raise awareness to the scope of the problem and make efforts to promote optimal care. On the one hand, individuals with IDD are exposed to many factors that increase the risk of both acute and chronic pain. On the other hand, pain may not be easily identified in individuals with IDD and may therefore go untreated. The risks for pain regarding different IDD etiologies will be discussed as well as the challenges that care takers face when trying to recognize pain and quantify its severity, including atypical, and at times paradoxical behaviors that people with IDD present. In addition, the new special interest group on pain in IDD will be presented and its missions and aims will be detailed.

10:45am EDT12:15pm EDT

Quantitative and Behavioral Approaches to Pain Assessment in IDD

Tracks: Pain In Special Populations
Categories: Topical Workshop

The presentation will provide an in depth review of the state of the science with respect to pain assessment issues and quantitative sensory testing approaches for clinical populations characterized by intellectual and/or developmental disabilities (IDD). Individuals living with IDD often have complex communication needs and myriad chronic health problems that make it difficult to accurately assess pain (including non-verbal individuals). Our understanding of underlying somatosensory mechanisms and function is extremely limited. This session will provide data-based analyses of approaches and outcomes based on integrating quantitative sensory testing into pain assessment approaches with clinical samples with IDD (including cerebral palsy, Down syndrome, and Rett syndrome). Issues related to measurement and QST approach (method of levels, method of limits) will be described and discussed in detail including a 'lessons learned' and recommendations for future research to improve our understanding of sensory mechanisms in relation to pain in IDD; a population not routinely considered in contemporary discussions focused on precision-based medicine and tailored pain treatment.

10:45am EDT12:15pm EDT

The Use of Cognitive Behavioural Techniques for Pain Management in People with an Intellectual Disability

Tracks: Pain In Special Populations
Categories: Topical Workshop

Several reviews have shown that non-pharmacological approaches to pain management are effective at reducing the burden of pain in the general population. Indeed, cognitive behavioral therapy (CBT) is recommended as the guiding therapeutic approach for multidisciplinary treatment programs by the British Pain Society. However, very little research has been undertaken to examine the acceptability or effectiveness of such approaches in people with ID. The use of psychotherapy is growing as part of the treatment of conditions such as depression and anxiety in ID but only a few studies have examined psychological treatments for pain management. In this presentation, research will be presented describing a case series utilizing modified cognitive behavioral therapy that showed preliminary evidence of benefit in a number of domains but evidence that the behavioral components were more easily understood than the cognitive components. Subsequently, a protocol was developed for the first clinical trial of CBT to manage menstrual pain in women with ID based on a manualized treatment program and results will be presented. These studies suggest a possible role for modified psychological therapies such as CBT.


Dr. Abraham J. Valkenburg

Department of Anesthesiology and Intensive Care, Isala Clinics, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands

Professor Ruth Defrin

Neuroscientists, and Chair of Tel Aviv university Pain research hub
Faculty of Medicine and Sagol School of Neuroscience, Tel-Aviv University, Israel

Professor Brian McGuire

Professor of Clinical Psychology
School of Psychology & Centre for Pain Research, National University of Ireland, Galway, Ireland H91 TK33

Professor Frank Symons

Department of Educational Psychology, College of Education + Human Development, University of Minnesota, Minneapolis