What is pain?

Pain is your body’s alarm system responsible for alerting you to injuries. The sensitivity of this alarm can be different between individuals. Some people’s alarms go off easily while others are harder to trigger.

How does the body respond to pain?

Your body has special cells that detect pain. When these special cells are activated, for example by touching a hot surface, they send a message to your brain that you are hurt or could be hurt. The brain uses this information to decide what actions need to be taken – in this case, removing your hand from the hot surface.

Your brain will respond to this pain in additional ways. Some examples are:

• releasing your body’s natural pain killers (e.g., endogenous opioids);
• sending special cells to the painful area to help fight infection and help with wound healing; and
• releasing chemicals that increase your experience of pain to make sure you get help.

How does prenatal alcohol exposure disrupt pain signalling?

Over half of individuals with Fetal Alcohol Spectrum Disorder (FASD) report having a high pain tolerance, while approximately 30% report having a low pain tolerance. There are a few possible explanations for this:

• One of the neurotransmitters (brain chemicals) involved in sensing pain is dopamine. How well dopamine works can be impacted differently depending on when the developing baby is exposed to alcohol. If the baby is exposed to alcohol early or continuously during pregnancy, this may make it harder for the pain system to be triggered. This is a problem because people with FASD may not know that they have an injury that needs medical attention (e.g., a sprained ankle, a pulled muscle, etc.). The opposite can also occur when the developing baby is exposed to alcohol during the mid- to late-term periods of pregnancy.
• A second neurotransmitter involved in sensing pain is serotonin. Serotonin is part of the body’s stress response system. Newborns prenatally exposed to alcohol have been found to have a less reactive stress response system, which in turn leads to less serotonin being released, and therefore less effective pain detection. Overall, there is a correlation between alcohol exposure and impairment in the pain signaling system – greater exposure is associated with greater impairment.
• How happy, sad, or anxious we are can also impact our pain sensitivity. Feeling sad and feeling anxious is associated with a lower pain threshold (we feel more pain than usual) because how we feel also affects dopamine and serotonin release. Dopamine and serotonin are often the targets of medications that make us feel happier and less anxious. Given that 90% of individuals with FASD report having mental health concerns, it is possible that the pain-sensing could be changed when receiving medicine for mood or anxiety disorders.

Does pain tolerance in individuals with FASD change over time?

The short answer is, yes. It has been shown that individuals with FASD who don’t show any significant sensitivity to light touch can become hypersensitive after an injury. This can ‘prime’ the body for chronic pain, such as chronic migraines.

FASD, Pain, and Medical Care

Some people with FASD will develop painful health problems, such as arthritis, much younger than someone without FASD. Because painful conditions like arthritis are normally seen in older adults, young people with FASD who present with painful conditions are often dismissed or not taken seriously by doctors. Doctors may think that the pain is simply due to growing or that patients are looking for strong pain medication or seeking attention. These situations are likely the result of doctors not having enough education about FASD and that FASD has only recently been accepted as a whole-body, and not just a brain-based, disorder.

Our full webinar about pain and FASD can be viewed here. To learn more about pain in children, check out Solutions for Kids in Pain, a Canadian knowledge mobilization network dedicated to providing Canadian’s with evidence-based information on pediatric pain.