Pain in adults with intellectual disabilities.

During the last 2 decades, the number of studies focusing on the experience, assessment, and treatment of pain in older persons with dementia has increased considerably [30]. One major conclusion of those studies [30] is that pain is still undertreated in this population due to the complexity of reliable pain assessment, which is a prerequisite for effective pain treatment. Unfortunately, these pain studies do not address other groups of persons who suffer from intellectual disabilities (IDs), such as Down syndrome (DS). The lack of knowledge on the experience, assessment, and treatment of pain in IDs is more remarkable still for 3 reasons: (1) persons with IDs may suffer from more painful conditions than controls do [29]; (2) the prevalence of age-related painful conditions is increasing due to increases in estimated life expectancy [5]; and (3) the neuropathology of IDs affects pain-related gray and white matter (Table 1), which may alter pain experience. The goal of the present topical review is, therefore, to gain more insight into the experience of pain in adults with IDs by (1) addressing epidemiological studies on the presence of musculoskeletal disorders in relation to clinical pain in people with IDs; (2) discussing the available experimental human studies on pain in IDs; and (3) presenting theoretical considerations about possible alterations in pain experience in IDs, based on the neuropathology characteristic of the various subtypes.