Until recently pain in people with disabilities received very little scientific attention. Individuals with disabilities have been systematically excluded from most research studies on pain. Expression of pain by these individuals is frequently variable and ambiguous, and its recognition by caregivers is idiosyncratic. These uncertainties present a tremendous challenge for clinicians and researchers alike. Even when pain-specific behaviors are present, such behaviors may be altered, blunted, or confused with other sources of generalized arousal. There is no reason to believe that pain is any less frequent in someone with a developmental or acquired disability, or that such an individual would be insensitive or indifferent to pain. Numerous functional limitations as well as the underlying neurological condition itself frequently confound the presentation of pain. Regardless of the degree of the disability, pain is often a part of daily life. How can pain be assessed and managed when typical means of verbal or nonverbal communication or cognition are altered or absent? In the absence of easily recognized verbal or motor-dependent forms of communication, it remains uncertain whether the pain experience itself is different or whether only its expressive manifestations are altered.
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