Chronic pain is defined as pain that persists for more than three months beyond the expected healing time for an injury or tissue damage (Treede et al., 2015). Dealing with chronic pain is a multifaceted experience; influenced by biological, psychological, and social factors.
For neurodivergent individuals, especially those with conditions like autism and attention-deficit hyperactivity disorder (ADHD), managing chronic pain can present some unique challenges. Sensory processing differences, challenges with recognising internal body states, and emotional regulation difficulties may all impact how pain is experienced and managed for neurodivergent individuals. To provide the best help for an individual living with chronic pain, it is vital to understand how these factors all interact.
Why Does Pain Persist?
Pain works almost like an alarm system, alerting your body when something is wrong, like an injury. Sometimes, however, this alarm system can become overly sensitive, like a smoke detector that keeps going off even when there is no fire. This heightened sensitivity, often referred to as central sensitisation, occurs when the brain and spinal cord start amplifying pain signals, making even mild sensations feel intense. This happens because the nervous system can change over time. It may undergo structural, functional, and chemical shifts that make it more reactive to pain signals. Importantly, even though some people may argue that chronic pain is “all in the head” or largely imagined, research shows that this pain is very real. It is a physical response to how the nervous system processes pain, even when there is no ongoing injury.
For people with autism or ADHD, differences in sensory processing may make pain responses less predictable. Some people may feel pain much more intensely, while others may not register pain right away, leading them to overlook or under-respond to injuries until discomfort becomes overwhelming. This unpredictability may make it harder to interpret bodily signals and manage pain effectively.
Additionally, chronic pain can interact with other challenges commonly experienced by neurodivergent individuals, such as heightened anxiety or sleep disturbances. Anxiety may amplify pain perception, while poor sleep can lower pain tolerance, creating a cycle that may make pain management even more difficult.
The Cycle of Pain, Fear, and Avoidance
Because pain acts as an alarm system, it naturally triggers fear and the urge to protect oneself. But when fear leads to avoiding movement or activities, it can create a cycle that reinforces pain and makes it worse. However, if you start avoiding movement entirely, your body can become more sensitive over time. Muscles may weaken, daily activities could feel harder, and pain signals may become even stronger.
Understanding this cycle is key to finding strategies that help retrain the nervous system and rebuild confidence in movement, rather than reinforcing the false alarm. For neurodivergent people who may already experience heightened anxiety or executive functioning difficulties, breaking this cycle can require extra care and tailored strategies that align with their strengths and needs.
The Impact of Chronic Pain on Mental Health
Chronic pain can also take a toll on one’s mental health. Many people with chronic pain also report feelings of anxiety and depression. One possible reason for why depression is common in people with chronic pain is increased difficulty with movement. When pain makes movement harder, people move less, leading to weakened muscles in the body. This may leave someone less able to do physical activities they used to enjoy, often leading to sadness or frustration. As well as this, the more a person avoids moving, the less energy and motivation they have, which may also increase their pain and lower their mood.
On top of that, chronic pain can lead to social isolation. When pain limits a person’s ability to do things or interact with others, it can impact relationships with family, friends, and loved ones. Over time, this isolation may make people feel more disconnected, increasing feelings of loneliness and depression. The emotional impact can make it even harder to break the cycle of pain, anxiety, and avoidance.
Tailored, Multidisciplinary Approaches
Because each person’s pain experience is unique, there is no single fix that works for everyone. That is why it is important to have a personalised treatment plan. The best approach we have so far is when a team of different experts work together, each bringing their own skills to the table. For instance, an occupational therapist might help change daily routines to make life easier, a speech pathologist may assist you in communicating or advocating for your needs effectively, and a psychologist could assist with addressing the cycle of fear that causes people to avoid moving and teach them how to cope with pain.
Even though pain might not go away completely, it is still possible to feel better and improve day-to-day life. For families supporting someone with chronic pain or neurodevelopmental conditions, understanding how all the pieces of the puzzle fit together can be really helpful. By combining health care, emotional support, and making small changes that fit the person’s needs, families can make a big difference in improving their loved one’s quality of life.
How Minds & Hearts Can Help
If you or someone you care about is dealing with the challenges of chronic pain and neurodevelopmental conditions, our team at Minds & Hearts is here to help. We offer personalised, multidisciplinary care to help individuals manage their pain and improve their quality of life. Contact us today to learn more or to schedule a consultation.
References
Bannon, S., Greenberg, J., Mace, R. A., Locascio, J. J., & Vranceanu, A. M. (2021). The role of social isolation in physical and emotional outcomes among patients with chronic pain. General hospital psychiatry, 69, 50-54.
Butler, D. S., & Moseley, G. L. (2013). Explain Pain 2nd Edn. Noigroup publications.
Bogdanova, O. V., Bogdanov, V. B., Pizano, A., Bouvard, M., Cazalets, J. R., Mellen, N., & Amestoy, A. (2022). The current view on the paradox of pain in autism spectrum disorders. Frontiers in psychiatry, 13, 910824.
Davies, L. (2020). The experiences of autistic adults with chronic pain conditions. Good Autism Practice (GAP), 21(2), 66-76.
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. The journal of pain, 17(9), T70-T92.
Elwin, M., Ek, L., Kjellin, L., & Schröder, A. (2013). Too much or too little: Hyper-and hypo-reactivity in high-functioning autism spectrum conditions. Journal of intellectual & developmental disability, 38(3), 232-241.
Han, G. T., Heavner, H. S., Rains, T. R., Hoang, A. H., & Stone, A. L. (2024). Chronic pain in autistic youth: Clinical prevalence and reflections on tailoring evidence-based interventions from an interdisciplinary treatment team. Children, 11(3), 312.
Liossi, C., & Howard, R. F. (2016). Pediatric chronic pain: biopsychosocial assessment and formulation. Pediatrics, 138(5).
Malfliet, A., Coppieters, I., Van Wilgen, P., Kregel, J., De Pauw, R., Dolphens, M., & Ickmans, K. (2017). Brain changes associated with cognitive and emotional factors in chronic pain: a systematic review. European Journal of Pain, 21(5), 769-786.
Panagiotidi, M., Overton, P. G., & Stafford, T. (2020). The relationship between sensory processing sensitivity and attention deficit hyperactivity disorder traits: A spectrum approach. Psychiatry Research, 293, 113477.
Scott, W., & McCracken, L. M. (2019). 54 Chronic Pain Management. Cambridge Handbook of Psychology, Health and Medicine, 246.
Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … & Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003-1007.
Verbunt, J. A., Seelen, H. A., Vlaeyen, J. W., van der Heijden, G. J., & Knottnerus, J. A. (2003). Fear of injury and physical deconditioning in patients with chronic low back pain. Archives of physical medicine and rehabilitation, 84(8), 1227-1232.
Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317-332.
Ward, J. (2019). Individual differences in sensory sensitivity: A synthesizing framework and evidence from normal variation and developmental conditions. Cognitive neuroscience, 10(3), 139-157.
Weiss, S., Sack, M., Henningsen, P., & Pollatos, O. (2014). On the interaction of self-regulation, interoception and pain perception. Psychopathology, 47(6), 377-382.
Lipsker, C. W., Hirvikoski, T., Balter, L. J., Bölte, S., Lekander, M., Holmström, L., & Wicksell, R. K. (2021). Autistic traits and attention-deficit hyperactivity disorder symptoms associated with greater pain interference and depression, and reduced health-related quality of life in children with chronic pain. Frontiers in Neuroscience, 15, 716887.
Yang, S., & Chang, M. C. (2019). Chronic pain: structural and functional changes in brain structures and associated negative affective states. International journal of molecular sciences, 20(13), 3130.