A companion to the main ADHD article, written for nurses.
Your feet have been screaming since hour three and you have not clocked it once, because you stopped listening to your own pain signals years ago to survive the noise of everyone else’s.
What this actually is
AuDHD brains already process pain and interoception differently, some signals arrive too loud, others do not arrive at all until they are a crisis. Add chronic pain on top and you get compounding: pain drains the same battery that attention and emotional regulation run on, so everything gets harder at once, not each thing separately.
How it shows up
In you, it looks like ignoring your own back pain through a double shift because you genuinely cannot locate it under the sensory noise of the unit, then crashing at home with pain you swear appeared out of nowhere. It looks like being short with a coworker at hour ten and not connecting that shortness to the pain you have been running on top of all day.
In your patients, it looks like the chronic pain patient whose reported pain score seems to make no sense next to their affect, too calm, too flat, too agitated, and gets flagged as drug-seeking or exaggerating. AuDHD interoception does not map cleanly to a 1 to 10 scale. A patient who cannot name their pain level accurately is not lying, their nervous system genuinely struggles to locate and quantify the signal.
What actually helps
For you: set a literal body check alarm, twice a shift, and ask yourself specifically about pain, not just “how am I doing.” Interoception needs a prompt, it will not just tap you on the shoulder.
For patients: use comparison and function questions instead of only the numeric scale. “Is this worse than yesterday” and “can you move your arm the way you could this morning” often gets a truer answer than “rate your pain.”
Do not treat a flat affect as proof of low pain, and do not treat distress as proof of high pain. Ask directly. Believe the answer.
One move today
Set a two-alarm body check for your own next shift, and use one function-based pain question with your next chronic pain patient.
The bottom line: pain and a dysregulated nervous system compound each other, in you and in the people you treat, and the fix starts with asking the actual question instead of trusting the scale or the face.
Go deeper
Read the full piece: AUDHD + Chronic Pain: The Compounding
ND Hive is coaching and community, not therapy or medical care.
Written by ND Hive.