The inability to communicate verbally does not in any way negate the possibility that an individual may be experiencing pain and may need appropriate treatment to relieve their pain. Pain can be expressed differently from one person to another. It can be difficult to decode and interpret and, as a result, can be underestimated by caregivers, particularly in people with multiple disabilities, due to their sensory specificities and unique communication modalities. Pain can thus result in an exacerbation of other somatic disorders (e.g., epilepsy) and behavioral disorders. People with multiple disabilities may also express pain differently depending on their environment and the type of pain (discomfort related to physical placement, temporary pain related to manipulation, chronic pain related to a health problem, etc.). Spasticity, dystonia, the oral and dental system, the digestive system (gastroesophageal reflux, constipation) and osteoarticular characteristics are often the cause of pain in people with multiple disabilities. The psychological challenges faced by people with multiple disabilities, such as separation and dependency-related living conditions, should also be considered. They experience each painful event individually, as their abilities to reason, gain perspective, and self-regulate are unique.

In this population, pain perception is influenced by the interplay of neurodevelopmental variations and complex medical conditions. Conventional methods of pain evaluation, which rely heavily on verbal self-report or observable reactions, often fall short in accurately representing the lived experiences of individuals with pain in people with profound intellectual and multiple disabilities. As a result, discomfort may manifest through subtle shifts in behavior, posture, or physiological parameters signs that require keen observation and a deep understanding of each person's baseline functioning.

Family members and clinicians alike must cultivate a nuanced awareness of the myriad ways pain can present itself. This may include increased agitation, withdrawal, moaning, changes in facial expression, or altered sleep and appetite patterns. External stressors ranging from environmental stimuli to procedural interventions can further complicate the clinical picture. Consequently, multidisciplinary collaboration and ongoing education are integral to improving recognition, assessment, and relief of pain for people with profound intellectual and multiple disabilities.

Pain in people with profound intellectual and multiple disabilities remains a complex clinical challenge, due to difficulties in recognizing, assessing, and managing their unique pain experiences. Sensory, motor, and cognitive impairments can lead to atypical signs of discomfort that are frequently missed or misinterpreted by healthcare professionals and caregivers. Recent research emphasizes the importance of a multidisciplinary approach to pain identification, considering behavioral cues, physiological changes, and contextual factors. It is crucial to adapt assessment tools and pain management strategies to the specific needs and capacities of this population, thus ensuring compassionate and individualized care.

Autism, People with profound intellectual and Multiple disabilities, PMID, Pain