{"id":866,"date":"2019-04-15T12:35:13","date_gmt":"2019-04-15T11:35:13","guid":{"rendered":"https:\/\/cristinaorozbajo.com\/autismo-la-experiencia-de-dolor\/"},"modified":"2019-04-15T12:35:13","modified_gmt":"2019-04-15T11:35:13","slug":"autisme-lexperiencia-de-dolor","status":"publish","type":"post","link":"https:\/\/cristinaorozbajo.com\/ca\/autisme-lexperiencia-de-dolor\/","title":{"rendered":"L&#039;EXPERI\u00c8NCIA DE DOLOR"},"content":{"rendered":"<ul class=\"\\&quot;wp-block-gallery wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\" columns-1 is-cropped\\\"><li class=\"\\\"blocks-gallery-item\\\"\"><figure><img src=\"\\\"https:><\/figure><\/li><\/ul>\n\n\n\n<p><strong>Qu\u00e8 \u00e9s la Hiper o hiposensibilitat? Pateixen els nens amb TEA hiper o hiposensibiliad? Com detectar-la? Com els podem ajudar? Al seg\u00fcent article s&#039;intenta resoldre aquests dubtes. <\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Molts pares i professionals que treballem amb nens i adolescents amb Trastorns de l\u00b4Espectre de l\u00b4Autisme (TEA) hem observat l\u00b4experi\u00e8ncia de les respostes irregulars d\u00b4una bona part dels nens amb TEA a est\u00edmuls dolorosos, generalment expressada com a menor sensibilitat (hiposensibilitat) al dolor, encara que tamb\u00e9 hi ha la hipersensibilitat. El DSM-5 inclou dins del grup B referent als patrons restrictius i repetitius de comportament un criteri que indica:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><em>Hiper o hiporreactivitat als est\u00edmuls sensorials o inter\u00e8s inhabitual per aspectes sensorials de l&#039;entorn (p.ex., indiferent aparent al dolor\/temperatura, respostes adverses a sons o textures espec\u00edfics, olfacte o palpaci\u00f3 excessiva d&#039;objectes, fascinaci\u00f3 visual pels llums o el moviment.<\/em><\/p>\n\n\n\n<p>En aquest article es refereix \u00fanicament al dolor f\u00edsic ia la hiposensibilitat al dolor, at\u00e8s els riscos que comporta per al nen amb TEA no verbal no poder expressar la seva experi\u00e8ncia dolorosa.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>QU\u00c8 \u00c9S EL DOLOR?<\/strong><\/p>\n\n\n\n<p>El dolor \u00e9s la integraci\u00f3 d&#039;una s\u00e8rie de percepcions f\u00edsiques que adverteixen la persona del risc de \u201cdany f\u00edsic\u201d o que aquest \u201cdany\u201d ja ha passat. No tots percebem igual el dolor, perqu\u00e8 a m\u00e9s de l&#039;experi\u00e8ncia f\u00edsica, aquesta percepci\u00f3 s&#039;acompanya d&#039;una s\u00e8rie d&#039;elements emocionals que poden fer variar la resposta. \u00c9s a dir, que el dolor \u00e9s una experi\u00e8ncia sensitiva i emocional desagradable associada a una lesi\u00f3 present o possible (Kandel E et al, 2000). Aqu\u00ed podem veure el primer punt, perqu\u00e8 la definici\u00f3 fa refer\u00e8ncia a la \u201cintegraci\u00f3 d&#039;una s\u00e8rie de percepcions\u201d i sabem que la integraci\u00f3-percepci\u00f3 sensorial presenta les seves irregularitats, problemes o difer\u00e8ncies dins de la poblaci\u00f3 amb TEA.&nbsp;<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Aquest dolor pot ser agut o cr\u00f2nic. El dolor agut \u00e9s un reflex d&#039;una lesi\u00f3 que activa mecanismes immediats de protecci\u00f3, t\u00e9 aquest sentit: protegir-nos. Ara b\u00e9, el dolor cr\u00f2nic no t\u00e9 sentit, senzillament \u00e9s l&#039;experi\u00e8ncia persistent al llarg del temps del resultat d&#039;una lesi\u00f3 o mecanismes fisiol\u00f2gics que s&#039;han alterat com a conseq\u00fc\u00e8ncia d&#039;aquesta lesi\u00f3.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>COM PERCEBEM EL DOLOR?<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>El dolor \u00e9s una percepci\u00f3 complexa. Per simplificar aquest complex mecanisme recorrerem a un esquema, sense entrar als complexos mecanismes neurals que ofereixen el substrat per a la sensaci\u00f3-percepci\u00f3 del dolor.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Els nociceptors reben informaci\u00f3 i desencadenen una resposta de protecci\u00f3 immediata que es reflecteix.<\/li><li>Posteriorment el dolor \u00e9s localitzat i hi ha una resposta d&#039;alerta general a l&#039;individu que ja \u00e9s plenament conscient de l&#039;est\u00edmul sentit i percebut. El dolor \u00e9s una experi\u00e8ncia sensorial i emocional alhora.<\/li><li>Tot seguit es produeixen canvis conductuals.<\/li><li>Es busca l&#039;analg\u00e8sia i s&#039;aconsegueix, a diferents graus, a trav\u00e9s de diversos mecanismes. <\/li><\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>QUINES ALTERACIONS S&#039;OBSERVEN EN ELS NENS AMB TEA EN RELACI\u00d3 AL DOLOR?<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>El punt que preocupa \u00e9s la hiposensibilitat al dolor i el conseq\u00fcent risc de patir lesions importants sense alertes que ens permetin detectar-les. Per\u00f2 tamb\u00e9 un altre punt \u00e9s important: hiposensibilitat no implica que no faci mal, literalment significa que fa menys mal. El gr\u00e0fic seg\u00fcent cerca consolidar informaci\u00f3 referent als canvis relacionats amb la percepci\u00f3 del dolor en nens amb TEA:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Per completar aquest punt vull anotar algunes idees generals per a la reflexi\u00f3:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Els nens inevitablement experimenten dolor com a part de les seves vides di\u00e0ries i sovint depenen dels seus cuidadors per aconseguir alleujar aquest dolor. \u00c9s important, doncs, que els cuidadors siguin capa\u00e7os de recon\u00e8ixer les expressions de dolor i proveir de les mesures per alleujar-lo. En el cas dels nens amb dificultats en la comunicaci\u00f3, aix\u00f2 pot ser molt dificult\u00f3s. Les limitacions del llenguatge en aquesta poblaci\u00f3 poden contribuir a les limitacions en la comunicaci\u00f3 del \u201cseu dolor\u201d a altres (Messmer RL, 2008).<\/li><li>L&#039;activitat facial o les variacions a l&#039;expressi\u00f3 facial es presenten com l&#039;indicador m\u00e9s important per jutjar el dolor. Molts dels mecanismes per bregar amb el dolor es relacionen amb canvis en el comportament, dins d&#039;aquests els canvis en l&#039;expressi\u00f3 facial s\u00f3n freq\u00fcents i molt importants.<\/li><li>Poc trobem escrit sobre dolor en nens amb TEA a tota la bibliografia referent al dolor. Les seves dificultats en la comunicaci\u00f3 poden conduir a dos problemes: que el dolor no sigui reconegut i que el seu dolor quedi sense tractament (Alley CS, 2013).<\/li><\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>PRECAUCIONS QUE HEM DE PRENDRE<\/strong><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Hiposensibilitat al dolor, no implica que aquest no se senti o que no sigui perjudicial, com ja hem referit a l&#039;aparell anterior. Tots hem d&#039;estar alerta:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Passa als nens amb TEA que la sensaci\u00f3 de dolor per\u00f2 la seva interpretaci\u00f3 pot ser diferent. Aix\u00f2 implica la necessitat de cercar mecanismes per evitar, minimitzar i alleujar el dolor.<\/li><li>Encara que responguin poc al dolor, la possibilitat de dany f\u00edsic existeix i cal prevenir-lo. <\/li><li>Poden aprendre mecanismes no apropiats buscant provocar dolor com a forma de regulaci\u00f3 interna davant d&#039;est\u00edmuls excessius o molt demandants.<\/li><\/ol>\n\n\n\n<p>Quan els pot fer mal? Mesurar el grau de percepci\u00f3 del dolor \u00e9s complex, especialment en nens amb TEA que no s\u00f3n verbals. Una resposta prim\u00e0ria a qu\u00e8 hem d&#039;estar atents \u00e9s el plor, per\u00f2 no sempre passa. S&#039;han desenvolupat diverses escales la validaci\u00f3 de les quals s&#039;ha aconseguit en diversitat de grups (nens no verbals, amb discapacitats f\u00edsiques o intel\u00b7lectuals, etc.) a les quals en determinat moment es pot rec\u00f3rrer.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Finalment, es recomana estar atent a les expressions facials perqu\u00e8 poden ser el nostre \u00fanic indicatiu de la percepci\u00f3 d&#039;un est\u00edmul dolor\u00f3s.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>BIBLIOGRAFIA:<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\"><li><em>Allely CS. Pain sensitivity and observer perception of pain in individuals with Autistic Spectrum Disorder.&nbsp; <\/em><em>The scientific World Journal 2013.<\/em><\/li><li><em>Kandel ER, Schwarts JH, Jessel T. Principis de Neuroci\u00e8ncia, IV edici\u00f3.  Editorial McGraw Hill Interamericana d&#039;Espanya, SA, 2001.<\/em><\/li><li><em>Messmer RL, Nader R, Craig KD. Brief report: judging pain intensity in children with autism undergoing venipuncture.&nbsp; <\/em><em>Journal of Autism and Developmental Disorders 2008; 38: 1391-1394.<\/em><\/li><li><em>Prkarchin KM. Assessin pain by facial expression: facial expression a les nexus.&nbsp; <\/em><em>Pain Red Management 2009; 14(1): 53-58.<\/em><\/li><\/ol>\n\n\n\n<p>Text editat per Mariona Alsed\u00e0 Florensa de la p\u00e0gina de <a href=\"\/ca\/\"https:>Autisme Diari<\/a> i <a href=\"\/ca\/\"https:>Carlos Orellana<\/a> <\/p>","protected":false},"excerpt":{"rendered":"<p>\u00bfQu\u00e9 es la Hiper o hiposensibilidad? \u00bfSufren los ni\u00f1os con TEA hiper o hiposensibiliad? \u00bfC\u00f3mo detectarla? \u00bfC\u00f3mo podemos ayudarles? En [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":868,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[18],"tags":[38,129,130,131,132,133,134],"class_list":["post-866","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-investigacion","tag-autismo","tag-deteccion","tag-dolor","tag-hipersensibilidad","tag-hiposensibilidad","tag-precauciones","tag-tea"],"_links":{"self":[{"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/posts\/866","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/comments?post=866"}],"version-history":[{"count":0,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/posts\/866\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/media\/868"}],"wp:attachment":[{"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/media?parent=866"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/categories?post=866"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cristinaorozbajo.com\/ca\/wp-json\/wp\/v2\/tags?post=866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}