Your ADHD Brain and Pain: An approach to try

My ADHD friends and family are marvellous. They feel deeply, they are incredibly creative, they do well in unconventional environments, they solve problems quickly, they are fun to be with. To think of ADHD as a disorder is unhelpful. We just need to support those we love with ADHD with structure and systems. So. Here’s an approach to pain relief and chronic pain management for you ❤️

The ADHD brain is at a disadvantage with regards to pain processing. Neuroscientists think that there is a scarcity of dopamine in the synapses of ADHD brains. They also believe that ADHD brains poorly regulate noradrenaline (norepinephrine).

Dopamine and noradrenaline are useful for many things: powering the brain’s reward system; increasing vitality, driving motivation, increasing alertness and attention. They are also essential in calming down pain messaging. ADHD medications block a transporter in the synapse that prevents the re-uptake of dopamine and noradrenaline into the neuron. This allows more dopamine and noradrenaline to be released into the synapse.

So, if you don’t regularly use medication for your ADHD, if you get an injury, I recommend that you take your meds until it recovers. If you are going to have surgery, see the dentist or get a tattoo - I encourage you to take your meds.

It has also been proposed that poor cognitive and emotional control paired with risky behaviour, along with, “underlying neuroinflammation” all contribute to the link with ADHD and chronic pain.

A recent study (link) shows that people with ADHD are more likely to be anxious, have depression and catastrophise. These are three big predictors that pain will become chronic

If you have ADHD and chronic pain, you may need to see your doctor about how to treat your anxiety or depression. This 1 minute video explains how low dose antidepressants are used as a pain treatment too.

https://vimeo.com/1009196438

A therapist who uses cognitive behavioural therapy techniques will also help you to set goals, understand pacing and help with coping behaviours. CBT is used extensively by the NHS for people living with chronic pain. It intuitively feels helpful for the ADHD brain. CBT helps you to see the bigger picture and understand what is actually going on in your head.   

Pain education and coaching can also help. Here’s an exercise that I’d love you to try. First, get a pen and paper and write down one side of the page the acronym CAGED BIRDS. Beside each letter make notes on

C What you can control in your situation

A How you can get a sense of agency over your pain. This is important. Instead of running away from the pain and imagining how bad it will get, you need to sit with where it is right now. A useful affirmation might be: “This hurts right now but in six weeks time it will just be a memory.”

G What daily goals will help you see incremental improvement?

E Is your pain hot, sharp, throbbing, aching or pulling? Examine your pain with curiosity. Objectify it. You are not your pain.

D What are the best distractions?

B Where are you breathing? How fast are you breathing? Let your nervous system know that you are OK.

I how is pain instructing you and what do you need to hear? Is it in the same place? Is it stronger than before? How does it compare to yesterday, last week, last year? What triggers it? What relieves it?

R How can you reframe this situation? How can you reduce the fear that everything will get worse?

D If you were directing this scene in a movie of your life how would you want it to play out? What’s the best case scenario in this situation?

S How can you safely nudge your comfort zone. How can you stop pain from taking charge?

This exercise helps you feel a sense of control over a rubbish situation. A plan helps to reduce anxiety and catstrophisation. Read through your notes and find someone to talk your action points through with. Then put alerts, alarms and reminders in your phone so you can carry out your plan to live well despite your pain.

Your brain chemistry might put you at a disadvantage in terms of pain perception but your creativity and smarts will help you to figure out some work arounds. You’ve got this.