ADHD and Chronic Pain: What Doctors Miss - With Dr. Michael Lenz

If you have ADHD or Autism and deal with chronic pain, migraines, IBS, or unexplained fatigue, your doctors may be missing a critical connection that could finally explain why nothing seems to work.

For years, people with ADHD and autism have been told their chronic pain is "just normal" or "all in their head." But there's a neurological link between ADHD, autism, and conditions like fibromyalgia, migraines, and IBS that most doctors aren't trained to recognize. In this episode, Dr. Michael Lenz explains why these connections are overlooked, how to advocate for proper diagnosis when your symptoms aren't being connected, and what comprehensive treatment actually looks like when both your ADHD and chronic pain are managed together.

• Why stimulant medication can actually help with pain tolerance
• The diagnostic gap keeping patients stuck in fragmented care
• How to write your medical story so doctors finally listen
• Why "normal pain" is actually zero pain

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WHERE TO FIND US
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For Melissa:
🎙 Work with Melissa: https://likemindcoaching.com/

For Brianna:
🎙 Work with Brianna: https://understandingadhd.ca/


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ABOUT THE GUEST
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Who is Dr. Michael Lenz?
Dr. Michael Lenz is a dual-trained pediatrician and internist who has been diagnosing and treating ADHD in children since 1996 and in adults since the early 2000s. His expertise extends to chronic pain conditions, including fibromyalgia, migraines, IBS, and autoimmune disorders. He is the author of Conquering Your Fibromyalgia and hosts a podcast by the same name, where he explores the overlooked connections between neurodivergence and chronic pain.

Where to find Dr. Michael Lenz:
🌐 Website: https://www.conqueringyourfibromyalgia.com/
📺 YouTube: youtube.com/@cqrfibromyalgia
🎙 Podcast: Conquering Your Fibromyalgia

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RESOURCES MENTIONED 
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Book: Conquering Your Fibromyalgia by Dr. Michael Lenz

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🎙 MEET YOUR HYPERCAST HOSTS
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🔹 Melissa Llewellyn Snider — ADHD Coach, Educator & EP of Hypercast
Melissa helps overwhelmed adults with ADHD build systems for life and work that actually work for them.
📍 https://likemindcoaching.com/

🔹 Brianna Morton — ADHD Coach, Educator & Therapist
Brianna blends ADHD education with mental health support and practical tools for everyday life.
📍 https://understandingadhd.ca/

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LISTEN & CONNECT
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🎧 Spotify:
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🍎 Apple Podcasts:
https://podcasts.apple.com/us/podcast/hypercast-an-adhd-podcast/id1745350643

🌍 Website:
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📸 Instagram:
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LEGAL & DISCLOSURE
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Disclaimer:
This podcast is for educational and entertainment purposes only and is not a substitute for medical or mental health advice. Always consult a qualified healthcare provider regarding medication or treatment decisions.

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From time to time, we may share affiliate links. If you choose to use them

Melissa's Contact:
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 www.likemindcoaching.com

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Email: info@understandingadhd.ca
www.understandingADHD.ca

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Transcript

ADHD and Chronic Pain: What Doctors Miss

[00:00:00] Brianna: For a lot of people with ADHD and autism, chronic pain isn't just a separate diagnosis, it's part of the same story. Those migraines, that back pain, that exhaustion, they may all be connected. And today we're talking with a physician who's been connecting those dots when most doctors don't.

[00:00:17] 

[00:00:18] Melissa: Welcome to Hypercast. Hi, I am [00:00:20] Melissa Llewellyn Snider, an ADHD coach and educator. 

[00:00:23] Brianna: Hi, I am Brianna Morton. I'm a neuro affirming therapist and ADHD coach.

[00:00:27] Melissa: Today we are joined by Dr. Michael Lenz. He's a physician who works with people living with chronic pain conditions. He's the author of Conquering your Fibromyalgia and host of a podcast by the same name, where he explains why chronic [00:00:40] pain is so often misunderstood and missed.

[00:00:42] Welcome, Dr. Lenz. 

[00:00:43] Dr. Michael Lenz: Well, thank you so much for having me. Excited to be here.

[00:00:46] Melissa: excited to have you. 

[00:00:48] Brianna: Very excited. This is a very important topic.

[00:00:50] Melissa: Um, just as we're getting started, I'm really curious what made you start looking into the connection between ADHD and autism and chronic pain? I. 

[00:00:58] Dr. Michael Lenz: So [00:01:00] just by taking care of co-occurring. Conditions or neuro types, they happen to happen more often together, especially the ADHD connection. 

[00:01:12] recognizing, oh, these things co occurred in my patients more often. and these were patients when I was in [00:01:20] medical residency often stigmatized and misunderstood, especially in the whole fibromyalgia world 

[00:01:26] And then recognizing overlapping pain syndromes like irritable bowel, irritable bladder migraines, fatigue, fibromyalgia.

[00:01:36] All of these were mystery illnesses that people [00:01:40] didn't really understand well. Well, it turned out many of my patients had relatives who had this. And then as I started to learn about adult ADHD, that ADHD continues into adulthood, that many of them also had ADHD. So I diagnose their ADHD along with headaches would be less frequent [00:02:00] and they would have less pain or less fatigue as you start to recognize, and then you just start asking more questions, and it was almost like how people get screened for depression when they go to the doctor.

[00:02:11] And I'm like, well, just take a good history and I ask probing questions. Tell me what you were like in middle school, in elementary [00:02:20] school. What were your strengths? What were your struggles? What were you like socially? 

[00:02:24] Brianna: Can you talk a little bit about like those connections. 

[00:02:26] Dr. Michael Lenz: So besides just seeing that they happened a lot and the seems that the more distress somebody has, the more likely they are to be neurodivergent. Meaning if you [00:02:40] have two to three migraines a week versus two to three migraines a year, if you have IBS that just acts up when you eat the typical American diet and kind of just have some lifestyle splurges and it acts up, versus life is [00:03:00] almost a daily struggle with living with IBS. severe your fibromyalgia is, the more likely to have ADHD. 

[00:03:10] you work with both clients with ADHD and autism

[00:03:12] Brianna: do you have clients that come to you or even like people that you know in your everyday life that. It seemed to have like [00:03:20] a number of comorbidities and also have a DH, ADHD and autism. 

[00:03:24] Well,

[00:03:25] Dr. Michael Lenz: looking at aler stand lows, looking at

[00:03:27] Brianna: mm-hmm.

[00:03:28] Dr. Michael Lenz: looking at migraines and IBS, chronic fatigue syndrome, if you have fibromyalgia, we're gonna be looking at what percent have co-occurring ADHD, But are [00:03:40] usually not in isolation like most of my ALO Danlos patients. Meet the criteria for fibromyalgia. Um, 

[00:03:46] Melissa: Mm-hmm. 

[00:03:47] Dr. Michael Lenz: every one of my fibromyalgia patients one of other area in the body where they have chronic pain, usually multiple, like painful periods and they have migraines, [00:04:00] they have undiagnosed IBS that has been described but never actually formalized into the chart.

[00:04:06] And you're like, how long have you had this? Well, my whole life I've had stomach issues. 

[00:04:10] Melissa: Yeah. 

[00:04:11] Dr. Michael Lenz: are they they'll describe a migraine and it'll be, that's a migraine.

[00:04:15] Oh, I just call 'em bad headaches. Have you ever told a doctor, well, no. It's just my [00:04:20] normal, normal abnormal 

[00:04:21] Melissa: I

[00:04:22] Brianna: Yeah.

[00:04:22] Dr. Michael Lenz: good early age to not be a complainer.

[00:04:26] Brianna: you learn to be the good patient there's nothing wrong with you and, often get dismissed. And you know when somebody comes into the average doctor and they have pain everywhere, stopped [00:04:40] complaining because, well, you're normal, right? So stop complaining.

[00:04:44] one of my favorite things to say to people. Um, 'cause it was a shock for me when I learned this is the normal amount of pain is zero. Um, and is right like shocking because when I was growing up, like I was in pain constantly, had all of [00:05:00] the period problems, had back pain, um, hypermobility problems, like right, like all of the things.

[00:05:06] Um, and went to the doctor and was like, no, it's normal for me. It's normal. And finally someone was like, the normal amount of pain is zero. Like you should not be in pain daily. And our scales are all messed up. And you, in your talk, talked about how our pain [00:05:20] tolerances were different. Like it could be higher, but then women have like lower pain or higher pain tolerances.

[00:05:25] And ADHD is lower pain tolerance. Is that what you. 

[00:05:28] Dr. Michael Lenz: That's a really good point. So a lot of people come in and they will preface and say, well, you know, Dr. Lenz, I have a high pain tolerance. And almost all the [00:05:40] time I'm like, I think what you mean you is, you wanna say is you have a high complaint tolerance. But actually when we test you we do those sensory testing, most of the time you report pain at a lower amount of pressure or threshold [00:06:00] than a neurotypical person. But your complaint tolerance and you can mask Much higher. 

[00:06:09] 

[00:06:09] Dr. Michael Lenz: remember that picture of the hand, the study of putting your hand in

[00:06:14] Brianna: Yep.

[00:06:14] Dr. Michael Lenz: frozen, uh, ice water reporting pain at a lower threshold, and then just [00:06:20] treating somebody's ADHD. It almost normalized their pain, sensi sensory, uh, thresholds or increase their tolerance, right?

[00:06:28] Brianna: And that was with stimulant medication? 

[00:06:30] Dr. Michael Lenz: Yeah. With a stimulant two hours later, you know, they get a baseline with and without ADHD. They had those with ADHD. We pulled their handout quicker and [00:06:40] couldn't keep it in its long. And then the second half of the study, they gave them, methylphenidate, checked it two hours later and nearly normalized that. 

[00:06:50] Brianna: So just to reiterate, 'cause I think this is a really important point, um, stimulant medication, it seems, helps with pain tolerance. So if you're dealing with ADHD in a chronic [00:07:00] pain condition, which we're talking about, it's gonna be very likely that you probably have both. That, like treating your ADHD is one of the ways that you can help manage your chronic pain.

[00:07:09] Is that kind of what you're saying?

[00:07:10] Dr. Michael Lenz: Yes. And also there's a, the, the fatigue component when we look at fibromyalgia, chronic pain, but there's also a lot of fatigue that goes [00:07:20] into that. And brain fog or cognitive impairment.

[00:07:24] 

[00:07:24] Brianna: Yeah, talk to me about it. Talk to me about the brain fog and the fatigue.

[00:07:28] Dr. Michael Lenz: there's the insomnia part of this that is very often missed. Um, as many people have co-occurring restless leg syndrome and periodic limb movement disorder, [00:07:40] it's usually dismissed. And a high percentage of my autistic patients have this As well as ADHD. And when you treat it with different medications, the gabapentinoids are the preferred. It can profoundly improve their quality of life. 'cause they can actually sleep well and they can get re [00:08:00] into deep restorative sleep. And it's actually one of the reasons why an ADHD medicine may not be optimally working.

[00:08:05] 

[00:08:06] 

[00:08:06] 

[00:08:06] Dr. Michael Lenz: one of my favorite things that you were saying is like, when you have people come into your chronic pain clinic, you're like, well, you should probably get screened for ADHD, you should probably get screened for autism. And on our side of things, like the reverse is true if [00:08:20] someone's coming in with a DH, ADHD or autism, and I'm like, Hey, did you know that you're not supposed to have this level of period pain?

[00:08:25] Brianna: If you're hypermobile, you should probably get that checked out. Have you heard of pots like telling them all these things? And then a lot of these, um, like pain conditions or late diagnosed a DH adhd, autism, there's like a female connection, right? [00:08:40] There's a higher number of undiagnosed, uh, women with ADHD there, or they get diagnosed later in life and there's a higher number of women with like chronic pain conditions.

[00:08:49] This is all just very interesting because depending on which studies you look at, probably. Traditionally it's been nine one [00:09:00] ratio of women to men getting diagnosed with these chronic pain syndromes. I think they're more likely to come in and see a doctor for

[00:09:10] Mm-hmm.

[00:09:11] Dr. Michael Lenz: men are perceived as being more stoic. 

[00:09:13] Men are often underdiagnosed because they're like, oh, that's just, and they may not wanna come in and complain.

[00:09:19] So I think in one [00:09:20] sense the women are getting recognized more likely for the chronic pain syndrome, but groups are likethe study outta Japan where they had chronic pain

[00:09:30] Brianna: Mm-hmm.

[00:09:31] Dr. Michael Lenz: they did just screen them all for ADHD. These were adults none of them had a prior diagnosis of ADHD, but [00:09:40] when they did the more detailed testing had ADHD.

[00:09:43] So this whole group is getting missed

[00:09:46] Brianna: Yeah.

[00:09:46] Dr. Michael Lenz: recognition for ADHD 

[00:09:48] Brianna: Well, I was just gonna say, it sounds like this is where some of the, the connections are being missed is there's under diagnosis across gender groups, across like. Like ADHD. Autism is underdiagnosis in those groups and the [00:10:00] chronic pain, there's under diagnosis there, and that's maybe where some of these connections are getting missed.

[00:10:04] Dr. Michael Lenz: And I think the most profound point is that if we're missing this group of patients, I think they're showing up clinically. Most often in a chronic pain clinic, they're [00:10:20] showing up with a neurologist with severe headaches. You don't end up in a neurologist for migraines. If you are responding to typical migraine medicines,

[00:10:28] Brianna: Mm-hmm.

[00:10:29] Dr. Michael Lenz: showing up in the GI doctor's office. If you have mild IBS, you're not showing up at the pain clinic if you responded to typical medications, but I think a [00:10:40] lot of 'em are showing up with these conditions and they're getting missed.

[00:10:44] And then where do they go? They go to alternative medicine. And then they offer them that you really have mold toxicity, you have lead toxicity, you have this special concoction, and if many of them are autistic, they get into [00:11:00] black and white thinking. And I sometimes have to now tell them, actually, you're autistic and you have ADHD.

[00:11:08] You're not mold toxic. You've spent thousands of dollars, maybe tens of thousands dollars. I had a person who spent half of his retirement on chelation therapy, and when I tried and I [00:11:20] brought up the whole ADHD part of things, he, he never came back he bought into No, no, no, no. so, it's a whole group of people who are not getting help, 

[00:11:32] Brianna: I know that's a, a pain point for a lot of us is we're not receiving help. 

[00:11:35] 

[00:11:36] Melissa: you may go to a gastroenterologist, you may end up going to an [00:11:40] orthopedic, you may go to a neurologist, you go to all these doctors and they're not talking to each other. you made the suggestion of writing down your story, which I.

[00:11:48] think is a really great suggestion. Can you talk about that a little bit? 

[00:11:51] Dr. Michael Lenz: Writing down your story. I just had a patient yesterday with a lot of the things we're talking about, I said, you know, I'd love [00:12:00] to have you just write down more of your story going back.

[00:12:03] And it does two things. One, it's validating for them that a doctor actually wants to know about this, but rarely does the 47-year-old woman or 57-year-old woman who's coming in now a month and a half after, or six months after a a car accident [00:12:20] or getting CO they're like, well, it, it's all caused by my COVID or the car accident. But then actually say, write down your story and tell me what your strength struggles are when you were a child and every five years. I said, I want to know what you were like as an infant. I wanna know if you're colicky What were you like in elementary school? [00:12:40] What was middle school like? Both. When we think of academics, socially and symptoms, and often you hear somebody had stomach aches and headaches and went to the school nurse, didn't like school, got nauseous a lot and middle school was really hard But [00:13:00] writing down the story over time when people come back, it's also insightful for them wow, DR Lenz. I've been through a lot. 

[00:13:11] Melissa: then the positive part, it might be, well, there was this time when I was in my early twenties where would work out every day and I used to run half [00:13:20] marathons and I was eating really healthy and I was getting good sleep and I was doing great. And they forgot that. 

[00:13:27] So say someone who is having some comorbidity issues, they write their story down. How do they take this to their doctor? How do they actually get their doctor to listen? Because like you said, there aren't [00:13:40] many doctors that may put all the pieces together that are specifically trained to treat chronic pain in to ADHD and autism.

[00:13:48] Okay. 

[00:13:48] Dr. Michael Lenz: Yeah, and that's the biggest question I have that people send to me as just listeners and viewers of the podcast and YouTube channel [00:14:00] asking if I do virtual visits to their state or country, which I only do virtual visits in Wisconsin, or do you know anybody where I live that thinks like you and practices like you? And there's very few people that do this. So why I wrote the book and why I do the YouTube channel and podcast is that [00:14:20] hopefully humble clinicians who haven't written this off, 

[00:14:25] but hopefully humble enough to go Wow. Maybe I should be considering this. I hope it's the standard of care, just like how we evaluate people. Every time you go in once a year, most offices are doing [00:14:40] a PHQ nine screening for depression

[00:14:42] should people be looking for a chronic pain doctors? Should they be looking to their primary care

[00:14:46] so honestly, it ends up being fragmented care and there are maybe a few doctors out there who are gonna be able to be a med peds, internal medicine, pediatric trained who [00:15:00] are understanding that, or a family practice doctor or an internal medicine doctor. Probably most of those doctors are doing that because of a personal. Connection to ADHD. I think it's it's not a standard of care right now. 

[00:15:15] I, I personally have found it very hard to find doctors that like, have an integrative [00:15:20] mindset, when they're treating their patients. Um, but I'm curious, uh, as a patient, is there anything else that we could be doing to help ourselves? 

[00:15:28] talking to your doctor and primary care. Maybe you're new, move to an area your older doctor retires or moves that you were seeing. And one of the [00:15:40] questions you just would wanna ask is like, if you were getting an orthopedic procedure done, you would say, how many rotator cuff surgeries have you done this year or last year? Well, you weren't the one who, that's what they do. And then part of that is how often do you recognize and diagnose ADHD children [00:16:00] and adults? Often, what part of your practice and how comfortable do you feel with that? And if they go, yeah, I'm very comfortable with that. I, I work with that a lot. That's probably a great start. 

[00:16:15] just having a doctor who feels comfortable managing ADHD [00:16:20] is a huge part of their family practice doctor. And then may not know the connections to the other part, but at least they're comfortable managing that. And then they also know they take care of IBS and they take care of patients with chronic pain and fatigue, and have them in their practice. Whereas if you are going to a [00:16:40] psychiatrist, hard to be integrative because they're not managing any of the other conditions.

[00:16:44] Brianna: So I'm hearing come prepared with your whole story. Shop around a little bit if you can, or ask questions. Be curious about their experience. Don't be afraid to advocate for yourself. Ask for what you need. If that requires you to do a little bit of research beforehand, like bring [00:17:00] in stuff, being like, Hey, I know that there's a connection here.

[00:17:02] I'd like to try this. And they, and then they'll hopefully say, sure. So it's a lot of like self-driven, like, I need my life to be better rather than kind of waiting for the doctor to put the pieces together. 'cause it's your life. And you know, as you said earlier, like doctors just receive [00:17:20] like so much information all the time that they might not have your individual life story in mind when they're thinking about things.

[00:17:26] Dr. Michael Lenz: I often say if somebody's humble enough to admit they don't know everything. And just, it's a tricky balance because you can have people who are [00:17:40] taken aback by that. Oh, you think? Oh, okay. And they might label, and I think somebody who is not comfortable treating ADHD might perceive somebody as being a drug seeker, or, oh, you're just trying to manipulate.

[00:17:53] Just back in the days when somebody would come in and say, oh, this is what works for me. This is how much Oxycontin works for me. [00:18:00] And then they get labeled as, oh, you're a drug seeker. You just You're not even listening. And,

[00:18:04] 

[00:18:05] 

[00:18:05] Melissa: What's the importance of lifestyle management when it comes to dealing with everyday pain management? 

[00:18:13] Dr. Michael Lenz: you know, it isn't just give ADHD meds and everything is cured, but it, it's a little bit like getting a pair of glasses, right? [00:18:20] Glasses at least you can see.

[00:18:21] And now you can hit the baseball betterand at least you're equalized, Lifestyle also is so important when you're controlling chronic pain syndromes, getting good, consistent sleep. Same schedules. A lot of people with ADHD get into bad habits. Autistic ADHD people tend to be night owls, and [00:18:40] that's not a good, healthy thing if you aren't getting enough sleep. Poor sleep is. They're going to leave everybody in a higher level of pain. 

[00:18:48] that's so important to make sure that gets grounded and then gradually increasing your exercise. Many people at a both very low level of exercise, so gradually increasing that over time. Studies [00:19:00] show eating a much more plant strong diet has been shown to be helpful in reducing symptoms. people who have that are going to feel less pain. There's less connection with inflammation when it comes to things like osteoarthritis, rheumatoid arthritis, and autoimmunes conditions.

[00:19:17] a personal level,I have some health conditions and I've been a [00:19:20] vegetarian since I was eight. I've been a vegan for about 15 years, and if I did not follow a plant-based diet, I don't think I would be able to get out of bed. Um, the difference is night and day and, and not just by plant-based.

[00:19:31] Melissa: Like if I start eating cookies and like french fries that can be vegan, but I won't get out of bed. Like have to be good with my diet. Sometimes [00:19:40] it gets crappier and I feel the difference and I suffer for it. but having ADHD makes it harder because you have to be more disciplined and that's not the thing that we're good at. 

[00:19:51] Brianna: Yeah. 

[00:19:52] Melissa: it makes my life better, it doesn't mean it's easy And I have to keep trying at it. It is a constant experiment [00:20:00] of making sure that you can do your 

[00:20:01] best for yourself.

[00:20:02] 

[00:20:03] Dr. Michael Lenz: it's comes up so commonly is PDA, um, pathologic demand avoidance and pervasive desire for autonomy. And that plays such a big role, 

[00:20:14] Yeah, it can even be sometimes if you're telling yourself like, oh, I need to eat healthier. I need to exercise. Like [00:20:20] even that is enough to trigger the PDA.

[00:20:22] I think when someone hears, that they may need to make healthier lifestyle choices, they have a vision of what that looks like. I was watching this documentary once and some doctor had mentioned, list your top 10 favorite foods. That's where you start. So instead of like, I have to eat an all Mediterranean diet. How [00:20:40] about start with like pizza. Like how can you make that pizza healthier? Um, the things that you love? how can you, like, make them palatable to you and still make it better for your overall body and, and mental health and yada yada. 

[00:20:53] you like Mexican food? Um, just switch out the beans for the chicken. Have guacamole [00:21:00] instead of sour cream. Um, you have salsa already in there just modify, start with your foods.

[00:21:06] And it actually, it overlaps with being autistic is what are your safe foods and can we stretch that my wife's a dietician, she teaches people how to eat a plant-based diet. And we used to, when the kids [00:21:20] were little, call it cooking class, you know, what's in this soup? What is this? I'm like, you made it, it's called an onion or a pepper, or whatever.

[00:21:28] Right? So if they're part of that process, it's not as intimidating but it's, it's, but it is really hard. 

[00:21:35] 

[00:21:36] Dr. Michael Lenz: Dr. Lenz, if there was one thing that you could [00:21:40] say someone who has ADHD autism and chronic pain, 

[00:21:43] Melissa: would it be? 

[00:21:44] Dr. Michael Lenz: I hope that you're getting support by somebody who understands these connections. I hope that today, listening through this discussion, you feel validated that there's hope that there'll be more and more clinicians out there learning about these connections. And I think that [00:22:00] there are clinicians out there who are willing to learn, and hopefully you can get connected with clinicians like that and that these. Do have an impact on your quality of life and also that there's hope. You know, the subtitle to my book is, real Hope and Real Solutions for Real Pain, uh, [00:22:20] Evidence-Based Pain, Evidence-Based Solutions to Recognize All of these are all interconnected, hopefully your spouse, your loved one, your family can learn more about this, that what you're struggling with is real and how can they help [00:22:40] support you and understand that this is important. 

[00:22:43] Melissa: thank you So much. This has been incredibly informative. if 

[00:22:47] our audience wants to find you, where did they find you?

[00:22:49] Dr. Michael Lenz: I think the best way to get connected. Now I'm trying to put more of this information up on YouTube

[00:22:53] There's a podcast. there's the, the book if somebody's in Wisconsin, I see patients and [00:23:00] I do virtual visits with people in the state 

[00:23:02] Melissa: Brianna, where can our audience find you? 

[00:23:04] Brianna: You can find me@understandingadhd.ca.

[00:23:07] Melissa: And you can find me@likemindcoaching.com. Thank you so much for joining us. Thank you, Dr. Lenz. Bye everyone. 

[00:23:15] Brianna: Bye-bye.

[00:23:16]