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A Wondering on Neurodivergence and Persistent Pain

non-binary adult wearing a yellow and black striped long sleeved shirt and noise cancelling headphones on a yellow background.
Non-binary autistic adult protecting ears with sound cancelling headphones.

I feel I should start by saying I am not an expert on either of these subjects. I'm a layperson when it comes to neurodivergence, and while I may have some neurospicy tendencies, I don't think I'm quite a member of that club. While I am more educated than the layperson regarding persistent pain, and pain in general, I am perplexed, confused and frankly overwhelmed by the science related to pain. So, please hold those caveats dear as salt as I wade into this...

I recently was chatting with a patient who was identified* as ADHD as an adult. In fact, she is in her late 50s or early 60s and was identified within the last few years. So much of her life, previously mysterious and frustrating for her, suddenly started to make sense. But that's not what she see's me for, she comes to me for persistent pain. It's been there a long, long time, she can't really recall when it started or why, just that it's been there with her through the years. I don't exactly remember how we got turned to this topic but it's something I've been wondering about for a while.

The basis of this wondering was alluded to in some online discussion about pain and other comorbidities (I think anxiety and depression were among those) and it is the notion that maybe pain doesn't cause a mood disorder and maybe a mood disorder doesn't cause pain but rather a secret third thing is a cause for both issues and we just haven't found it yet. The thought "neurodivergence" immediately popped into my head and not for the first time.

My understanding of neurodivergence (ND) is that one is born with that neurotype. It's part of the hardware and the software one is born with. *This is why I use the term Identified rather than diagnosed as I do not believe it is a result of illness or damage but rather just how that person's brain is naturally. A common component for a lot of ND folks is hypersensitivity to sensory stimulation. Auditory processing issues, light sensitivity, sound sensitivity, tactile sensitivity, taste and texture sensitivities, are common struggles for ND people and can lead to extreme discomfort mentally and physically.

What if neurodivergence is a sort of bedrock for some of the complex and persistent issues we see in pain?

While working on my patient's painful hip I broached this idea. I said "we are still learning a lot about pain. I'm not the most educated person on it but from what I have gathered so far, it looks like we can have pain that is "issues in your tissues" and we can have pain that seems to just exist without provocation. Maybe there was an injury once upon a time but it is long recovered and yet the pain persists. And for some there doesn't seem to be a history of injury or incident that precedes the pain, it just showed up one day. This seems to be classed as 'nociplastic pain' which, (and I said the pain scientists were probably gonna slap my mouth for saying this as badly as I am about to) as far as I can tell, is when the sensory apparatus responsible for noxious stimuli changes and pain becomes a steady state. It's like the nociceptor, the part responsible for communicating noxious stimuli to the central nervous system, itself is in pain. The tension we find in the surrounding tissues might not be the cause but a consequence as the body responds with protective measures like muscle tension to limit mobility. If this is so, could it then be that perhaps there is an element of ND that makes one more vulnerable to develop this problem? Nervous systems prune their neural networks regularly the same way a garden pulls weeds or cuts back certain plants to grow the garden they desire. Neurodivergent nervous systems don't do this as neurotypical nervous systems do. They under or over prune which maybe leads to hypersensitivity and hyposensitivity to various stimuli. Well, what if this includes the structures and systems responsible for nociception?"

We both poked at this idea, and it made a lot of sense to the both of us. Now of course, I know next to nothing about these subjects, so I could be so far out in left field I'm not even in the game anymore, but... maybe I'm not? We tend to think about neurodivergence as how a mind works, but what if it's more broad than that? What if people with innate, incredible balance are expressing neurodivergence? What if people who are really poorly coordinated are also expressing neurodivergence? What if people who seem to find many things typically considered painful as minor irritations are neurodivergent? And what if people who seem to find many things painful, are neurodivergent?

It's a wondering and a great one for a research rabbit hole I wish I had the time to fall into. Perhaps I will go looking and see what I can find. Or perhaps you already have and have something cool to share? I'd be delighted to read it.

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