This section of the library shall be dedicated to commentaries on the Hubermanlab podcast. Included below is not a summary of the episode (I’ll leave that for you to check out), but rather my comments on the episode in terms of psychology, health, and human behavior. Whenever possible, I draw connections to autism as well. Most of my comments originally appear on Twitter/X, so be sure to follow on there.
Dr. Sean Mackey: Tools to Reduce & Manage Pain
Increased Anxiety From Expected Pain Increases Perceived Pain
I previously commented on Dr. Huberman’s X/Twitter regarding increased pain expectation and its relation to higher pain perception. I wondered its connection to autism as far as some individuals on the spectrum may experience reduced pain as a result of not having pain expectations.
This is something I’m interested in because many children with autism seem to have carefree no-attention-to-hazards-in-the-environment attitudes -although in some cases potentially exacerbated by comorbidities, such as ADHD or other developmental delays. My joke regarding ‘carefree attitudes’ is a lighthearted approach to a serious matter for many parents. Nevertheless, I wondered if perhaps many children with autism have reduced pain perception because they feel little to no anxiety about hazards in the environment. Or vice versa, they feel no anxiety at all about pain coming from stimuli in the environment and therefore reduced pain perception. The direction of that relationship seems a little fuzzy to me, and I would personally place other behavioral factors into the equation -such as, what is the reward of overlooking said stimuli versus the cost of falling into a hazard, versus overlooking the stimuli and being rewarded by other stimuli, etc.
Behavior analysts can make things complicated…
But anyway.
I wanted to educate myself a little further on the matter, so I read a 2022 literature review [1]. Regarding research on the anticipation of painful stimuli, differences among individuals with autism might be explained by another factor: attention. In one study, individuals with autism were required to direct their attention to an incoming painful stimuli. The adults on the spectrum that participated in that study had to also choose the type of noxious stimuli that would bother them. The results? Those with autism had higher activation in the anterior cingulate cortex than the control group during the anticipation phase, while no differences during the actual painful stimulus. What’s also curious, is that the adults in the study chose a noxious stimuli that had a lower level of pain than the control group. Fascinating!
However, I do wonder the degree to which these findings are applicable to young children with autism who in some cases may have severe attending deficits. Or perhaps the expectation of reward outweighs the expectation for a painful stimulus. Or perhaps the child experiences a type of ‘tunnel vision’ when they become so fixated on the cookie, their attention and focus is only on the cookie and not on the barriers to getting it. Maybe they also had forgotten they had just left their red toy truck on the floor, so long-term memory might also be brought into the equation. A lack of remembering having placed the toy truck leading to decreased pain expectation, leading to an impulsive rushing for the cookie in the kitchen … So, there’s lots of factors at play depending on the child.
Opioids
Endogenous Opioids and Autism
Dr. Mackey discusses endogenous opioids (the ones we make naturally in our brain) needed to function in our everyday lives. The literature review on pain and autism actually devoted a section to opioids and proposed future research examine the brain’s endogenous opioid system in understanding autism, specifically in understanding pain sensitization, hypothesized opioid release through self-injurious behavior, as well as social behaviors, among other things [1]. There is apparently very little research in this area.
Prescription Opioids and Autism
I did happen upon a study by the CDC that found an association between preconception opioid prescription and autism [2]. It was associated with 2.43 times the odds of ASD and 2.64 times the odds of ASD/ DD with autism features. Unfortunately, the researchers indicate the analysis was likely underpowered. Nevertheless, it might help shed further light on the autism epidemic if further research replicates such findings. This study was cited in the literature review mentioned previously within the context of hypothesized endogenous opioid disruption in autism [1].
Pain as an Adaptive Mechanism
Dr. Huberman posed an interesting question regarding pain as an adaptive mechanism. He discussed considerations regarding how much pain relief to provide ourselves or someone else at the expense of not allowing the pain to serve its function of alerting us that something is wrong. Dr. Mackey shared a perfect answer: if the pain is getting in the way of following your everyday life, then you should reduce that pain.
Pain Thresholds
It was shared by Dr. Mackey that men have higher thresholds of pain to heat than women. This is interesting within the context of autism, and before reading the literature review I hypothesized that boys with autism would have an even higher threshold of pain to heat. Seem like an obvious enough hypothesis, right?
Apparently there is research that finds the reverse to be true: those with autism have lower pain from heat thresholds than neurotypical controls [1].
The literature on pain and autism is a bit weird, and the authors make note of this quite well. For example, some with autism experience paradoxical heat sensation. This means instead of feeling heat you feel a gentle cooling. Additionally, some individuals with autism experience no pain at at all to pinprick induced mechanical pain. Conversely, other individuals with autism may experience hypersensitivity to stimuli usually considered painless. To make matters more inconsistent, some individuals with autism may experience both hyper- and hyposensitivity to the same stimuli -although the authors do note that confounds such as ‘attention to the stimulus’ might be at play.
As a researcher attempting to bring about various literature(s) on autism together, one question I have right now is: how do environmental factors associated with autism play into hyper- or hypo-sensitivities to various pain producing stimuli? The literature review did not discuss environmental factors associated with autism, but this would be a completely new line of research that, to my knowledge, is probably entirely unexplored. Here’s a research question: do individuals diagnosed with autism who were prenatally exposed to pesticides experience a specific type of pain hypo- or hyper-sensitivity? Are there differences in pain sensitivity between those who were prenatally exposed to pesticides versus ambulate particulate matter (aka, air pollution)? Lots of areas to explore…
Tylenol and Pain
Ooooh. Dr. Mackey brought up Tylenol. Hehe.
I wonder if he knows about the Tylenol-Autism lawsuits? He discussed the key with Tylenol is not go exceed 4 grams per day, that it’s safe on the stomach, and that “the key is around the liver.” I remember one of the arguments in an article on Tylenol and Autism was that even laboratory pup-rats given lethal doses of Tylenol wouldn’t suffer any liver damage [4]. They argued “the liver is not the target organ for paracetamol-induced toxicity during early development, and liver damage should probably not be used as a measure of paracetamol toxicity in babies and small children.”
I won’t go on a tangent about Tylenol. But it is heavily on my mind due to a recent commentary on the Tylenol-Autism lawsuits I wrote. So, the discussion around Tylenol as a pain relief mechanism brought it all up.
Swearing and Pain Reduction
Dr. Mackey shared that swearing can function as a mechanism to reduce pain. Hilarious! I joked on Twitter/X that maybe that’s why David Goggins swears so much.
The guy must feel no pain as a result.
No wonder he can seemingly run forever.
He just swears his way through the whole thing.
He cusses at you. He cusses at himself. He cusses at the people cheering.
That must be his secret…
Positive Emotional Salience for Pain Reduction
Dr. Mackey shared during the episode that positive emotional salience can function as a pain reduction mechanism. Especially love; love reduces pain.
Not according to Nazareth.
According to Nazareth: love hurts. Love scars.
Just kidding.
I actually loved that Dr. Mackey shared that research because it makes perfect sense. I wonder if the findings can be extended to not just love for a significant other, but perhaps love of life, love of God/Spirit/(whatever you call it). I would hypothesize that this would be determined by the extent to which those same neural circuits are activated and to that same intensity. I ask this question because many spiritual practices include practicing unconditiontal love toward others, oneself, and toward all of life. One Buddhist/Hindu practice includes what is called Ahimsa, which means nonviolence. I recall fondly that one scene in Karate Kid 3 where the monk savages a cockroach from being killed by a shoe… So, love and respect for all life.
Thus, I wonder to what extent love toward all of life can ameliorate pain.
Initial Pain
Apparently I share a similar pain threshold and experience as Dr. Huberman. If I stub my toe or similarly hurt myself in another manner, I seem to experience a lot of the pain all at once but then it’s also gone quickly.
Maybe if I cuss more it’ll also go by more quickly (I’m not huge on swearing). Although Dr. Mackey did mention that anger can make pain worse, so this would be a fine distinction, I think.
Nutrition, Pain…and Autism
Dr. Mackey shares that good nutrition, anti-inflammatory diets, and avoiding foods that are triggers can positively impact pain. This is interesting as well within the field of autism, whereas many individuals with autism experience food sensitivities -which Dr. Mackey indicates he is also seeing more of.
Prior to this Hubermanlab episode, I had started reading a study that conducted a National Survey on diets and autism symptoms [5]. The study had caregivers (87% of survey respondents) or adults on the autism spectrum (or Asperger syndrome, Pervasive Developmental Disorder, etc.) complete a survey of 7 parts, including sections such as medical history, medications, diets, education, etc. Information regarding autism severity was inquired for 3 years of age, as well as at the time of the questionnaire. The results were fascinating, and are too many to go into detail, but I’ll share a few.
Ketogenic diet was top 3 for having positive effects on: anxiety, attention, cognition, constipation, depression, language/communication, lethargy, OCD, reflux/vomiting, seizures, self-injury, falling asleep, staying asleep, social interaction and understanding, and stimming behaviors.
The corn-free diet was the best for diarrhea.
The Feingold diet was the best for aggression.
The Feingold diet was the best for hyperactivity, with the Low Sugar diet only behind by 2%.
Finally, and perhaps most surprising of all, is that the Overall Benefit score averaging the benefits of all of the therapeutic diets was higher compared to nutraceuticals or psychiatric/seizure medications. Wow!
One of the authors’ concluding remarks was:
“Since most physicians actually receive very little nutrition education in medical school, it is recommended that families find a physician who has that training and/or work with a nutritionist experienced with therapeutic diets for autism spectrum disorder.”
These findings are quite fascinating and should help promote further research into the use of diet to ameliorate various health symptoms, most notably, autism symptoms.
All in all, this conversation with Dr. Mackey was really educational and enjoyable. Thank you both.
As always, thanks for the lovely episode Dr. Huberman.
Autism Librarian
References
- 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. https://doi.org/10.3389/fpsyt.2022.910824
- Rubenstein, E., Young, J. C., Croen, L. A., DiGuiseppi, C., Dowling, N. F., Lee, L. C., Schieve, L., Wiggins, L. D., & Daniels, J. (2019). Brief Report: Maternal Opioid Prescription from Preconception Through Pregnancy and the Odds of Autism Spectrum Disorder and Autism Features in Children. Journal of autism and developmental disorders, 49(1), 376–382. https://doi.org/10.1007/s10803-018-3721-8
- Matthews, J. S., & Adams, J. B. (2023). Ratings of the Effectiveness of 13 Therapeutic Diets for Autism Spectrum Disorder: Results of a National Survey. Journal of personalized medicine, 13(10), 1448. https://doi.org/10.3390/jpm13101448
- Patel, E., Jones Iii, J. P., 3rd, Bono-Lunn, D., Kuchibhatla, M., Palkar, A., Cendejas Hernandez, J., Sarafian, J. T., Lawton, V. G., Anderson, L. G., Konsoula, Z., Reissner, K. J., & Parker, W. (2022). The safety of pediatric use of paracetamol (acetaminophen): a narrative review of direct and indirect evidence. Minerva pediatrics, 74(6), 774–788. https://doi.org/10.23736/S2724-5276.22.06932-4
- Matthews, J. S., & Adams, J. B. (2023). Ratings of the Effectiveness of 13 Therapeutic Diets for Autism Spectrum Disorder: Results of a National Survey. Journal of personalized medicine, 13(10), 1448. https://doi.org/10.3390/jpm13101448
The Causes of Autism 