Pain insensitivity and indifference: alternative explanations for some medical catastrophes

Communication difficulties are a commonly cited barrier to health-care provision for individuals with developmental disabilities. However, an examination of the medical and psychological literature on pain suggests that alternative explanations for some instances of medical catastrophe are pain insensitivity or pain indifference. Although the proportion of case studies of pain-absent individuals who also have developmental disabilities is much higher than would be expected given the size of this subpopulation, proper incidence studies have not been conducted. Reinterpretation of a study on intestinal obstruction-caused mortality suggests that there is a pressing need for such incidence studies.