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IntroductionNociplastic pain (NP), classified as a third type of pain alongside nociceptive and neuropathic pain, is chronic pain arising from the amplification of nociceptive stimuli through central sensitization, despite the absence of tissue damage, sensory nerve damage, or disease. An important clinical feature of NP is that it is not only associated with pain but also with sensory hypersensitivity to sound and light and cognitive dysfunction, including mood and attention disorders. Recent studies have suggested that depression and developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), coexist with NP at high frequency. Additionally, cognitive impairment in individuals with NP may be associated with these psychiatric comorbidities. However, to our knowledge, there are no reports on (1) multidimensional evaluation and diagnostic details of abdominal NP in adults with ADHD/ASD; (2) how ADHD drugs and antidepressants are administered when ADHD and depression coexist with NP; and (3) how central sensitization, brain function, and family relationship problems underlying NP are altered by treatments of ADHD and depression.Case presentationHerein, we present the case of a 51-year-old woman with abdominal NP. She developed severe right lower abdominal pain and underwent a thorough medical examination; however, the physical, medical cause remained unknown, making treatment challenging. Additionally, she took time off work as she began to complain of insomnia and anxiety. She was referred to our pain center, where a diagnosis of depression, ADHD, and ASD was confirmed, and treatment with ADHD medication was initiated. While ADHD medications alone did not yield sufficient improvement, a combination of methylphenidate and the antidepressant venlafaxine eventually led to improvements in abdominal NP, depression, ADHD symptoms, central sensitization, and family relationship issues. During treatment, cerebral blood flow in the anterior cingulate, prefrontal, and parietal cortices also improved.ConclusionThe treatment of comorbid depression is important while treating NP, and venlafaxine may be effective, especially in cases of comorbid ADHD/ASD. Screening for developmental disorders and depression is required in patients with abdominal NP.

Abstract The hazardous plasma environment surrounding Earth poses risks to satellites due to internal charging and surface charging effects. Accurate predictions of these risks are crucial for minimizing damage and preparing for system failures of satellites. To forecast the plasma environment, it is essential to know the current state of the system, as the accuracy of the forecast depends on the accuracy of the initial condition of the forecast. In this study, we use data assimilation techniques to combine observational data and model predictions, and present the first global validation of a data-assimilative electron ring current nowcast during a geomagnetic storm. By assimilating measurements from one satellite and validating the results against another satellite in a different magnetic local time sector, we assess the global response and effectiveness of the data assimilation technique for space weather applications. Using this method, we found that the simulation accuracy can be drastically improved at times when observations are available while eliminating almost all of the bias previously present in the model. These findings contribute to the construction of improved operational models in estimating surface charging risks and providing realistic ’source’ populations for radiation belt simulations.

Abstract Variations of relativistic electron fluxes (E ≥ 1 MeV) and wave activity in the Earth magnetosphere are studied to determine the contribution of different acceleration mechanisms of the outer radiation belt electrons: ULF mechanism, VLF mechanism, and adiabatic acceleration. The electron fluxes were measured by Arase satellite and geostationary GOES satellites. The ULF power index is used to characterize the magnetospheric wave activity in the Pc5 range. To characterize the VLF wave activity in the magnetosphere, we use data from PWE instrument of Arase satellite. We consider some of the most powerful magnetic storms during the Arase era: May 27–29, 2017; September 7–10, 2017; and August 25–28, 2018. Also, non-storm intervals with a high solar wind speed before and after these storms for comparison are analyzed. Magnitudes of relativistic electron fluxes during these magnetic storms are found to be greater than that during non-storm intervals with high solar wind streams. During magnetic storms, the flux intensity maximum shifts to lower L-shells compared to intervals without magnetic storms. For the considered events, the substorm activity, as characterized by AE index, is found to be a necessary condition for the increase of relativistic electron fluxes, whereas a high solar wind speed alone is not sufficient for the relativistic electron growth. The enhancement of relativistic electron fluxes by 1.5–2 orders of magnitude is observed 1–3 days after the growth of the ULF index and VLF emission power. The growth of VLF and ULF wave powers coincides with the growth of substorm activity and occurs approximately at the same time. Both mechanisms operate at the first phase of electron acceleration. At the second phase of electron acceleration, the mechanism associated with the injection of electrons into the region of the magnetic field weakened by the ring current and their subsequent betatron acceleration during the magnetic field restoration can work effectively. Graphical Abstract

Dynamic stretching (DS) is performed as a warm-up to improve the range of motion and athletic performance. However, the effect of different amounts of DS on muscle performance remains unclear. This study investigated the effects of DS repetitions with one or four sets of 30 s on musculotendinous extensibility and muscle strength. Fourteen healthy men (23.6 ± 1.5 years) underwent DS to ankle plantar flexors for one set (fifteen repetitions) or four sets after warm-up. The maximal ankle dorsiflexion angle, musculotendinous stiffness (MTS), passive torque, peak plantarflexion torque during maximal isometric contraction, and muscle temperature were measured before and after stretching. A significant effect of time was observed on the maximal ankle dorsiflexion angle, MTS, passive torque, and muscle temperature (p < 0.001). However, no interactions or effects between the conditions were observed. After DS, the maximal ankle dorsiflexion angle and muscle temperature significantly increased (p < 0.01), while the MTS and passive torque significantly decreased (p < 0.01). The maximal muscle strength showed no significant effects or interactions (p = 0.198−0.439). These results indicated that one and four sets of DS effectively increased musculotendinous extensibility. Thus, one set of DS may have similar effects as a warm-up before four sets of DS.

Abstract The in situ measurement of charged particles plays a key role in understanding space plasma physics. Velocity distribution functions of ions and electrons have been acquired with electrostatic analyzers onboard spacecraft. Since conventional energy analyzers (e.g., top-hat electrostatic analyzers) have essentially a two-dimensional field of view, the solid angle coverage is achieved with the aid of spacecraft spin motion or with additional entrance deflection systems in front of the electrostatic analyzer. In the latter case, however, the full angular scan is realized only in the lower energy range (typically only up to 5–15 keV/e), due to the limitation of the electric field applied to the deflector. Here we propose a novel deflection system for extending the energy coverage up to tens of keV. This is especially useful for plasma observations in situations where the anisotropy of the energetic part (> 10 keV) of charged particles plays an essential role in plasma dynamics and hence is of significant interest. Graphical Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD.

Background and aimThe suspensory strategy, a method for controlling postural balance in the vertical direction of the center of mass (COM), is considered by the elderly as a means of balance control. The vertical COM control might alter the sensory integration and regularity of postural sway, which in turn impacts balance. However, to date, this was not confirmed. Thus, this study aimed at investigating the influence of the suspensory strategy achieved through knee flexion on the static standing balance.MethodsNineteen participants were monitored at knee flexion angles of 0°, 15°, and 65°. Time-frequency analysis and sample entropy were employed to analyze the COM data. Time-frequency analysis was utilized to assess the energy content across various frequency bands and corresponding percentage of energy within each frequency band. The outcomes of time-frequency are hypothesized to reflect the balance-related sensory input and sensory weights. Sample entropy was applied to evaluate the regularity of the COM displacement patterns.ResultsKnee flexion led to a decreased COM height. The highest energy content was observed at 65° knee flexion, in contrast with the lowest energy observed at 0° in both the anterior–posterior (AP) and medial-lateral (ML) directions. Additionally, the ultra-low-frequency band was more pronounced at 65° than that at 0° or 15° in the ML direction. Furthermore, the COM amplitudes were notably higher at 65° than those at 0° and 15° in the AP and ML directions, respectively. The sample entropy values were lower at 65° and 15° than those at 0° in the ML direction, with the lowest value observed at 65° in the vertical direction.ConclusionThe suspensory strategy could enhance the sensory input and cause sensory reweighting, culminating in a more regular balance control. Such suspensory strategy-induced postural control modifications may potentially provide balance benefits for people with declining balance-related sensory, central processing, and musculoskeletal system functions.

Abstract Attention-deficit/hyperactivity disorder (ADHD) has been reported to be associated with primary chronic pain syndromes, such as fibromyalgia, migraine, and chronic low back pain. Although idiopathic orofacial pain (IOP) is classified as burning mouth syndrome or persistent idiopathic facial or dentoalveolar pain and as a primary chronic pain, the association between IOP and ADHD has not been investigated. This retrospective cohort study investigated the severity of ADHD symptoms measured using the ADHD scale and the effects of treatment using ADHD drugs and the dopamine system stabilizer aripiprazole. The participants were 25 consecutive patients with refractory IOP referred to a psychiatrist and diagnosed with coexisting ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5. The ADHD scale scores were higher in patients with intractable IOP than those in the general population. Pharmacotherapy used in this study led to clinically significant improvements in pain, anxiety/depression, and pain catastrophizing. Intractable IOP and ADHD were shown to be associated. In the future, screening and pharmacotherapy for ADHD should be considered in the treatment of intractable IOP.

Core exercises on an unstable surface increase trunk muscle activity, especially for local muscle groups. Therefore, there is a possibility that exercises on an unstable surface would be effective in the rehabilitation of non-specific chronic low back pain (NSCLBP). The present study assessed trunk muscle activities during bridge exercise on the floor and two kinds of unstable surfaces, i.e., a balance ball and the BOSU, for individuals with and without NSCLBP. This study enrolled 17 and 18 young participants with and without NSCLBP, respectively. In the balance ball condition, both groups showed a significant increase in erector spinae activity compared to the floor condition, and the increase in activity was significantly greater in the NSCLBP group than in the control group (p = 0.038). On the other hand, neither group showed significant changes in trunk muscle activities in the BOSU condition compared to those in the floor condition. The control group showed a significant increase in internal oblique/transversus abdominis activity under the balance ball condition (p = 0.020), whereas there were no significant changes in these muscle activities between the balance ball and floor conditions in the NSCLBP group. The present study showed that participants with NSCLBP significantly increased muscle activity of the erector spinae, one of the global back muscles, on the balance ball in spite of small effects on muscle activity of the internal oblique/transversus abdominis, which is one of the local abdominal muscles. Therefore, attention should be paid to the application of bridge exercises on the balance ball for individuals with NSCLBP.

The Martian atmospheric Ne may reflect recent gas supply from its mantle via volcanic degassing, due to its short (∼100 Myr) escape timescale. The isotopic ratio of the Martian atmospheric Ne would therefore provide insights into that of the Martian mantle, further suggesting the origin of Mars volatiles during planetary formation. Mass spectrometric analysis of the Martian atmospheric Ne, however, has faced challenges from interference between ^20 Ne ^+ and ^40 Ar ^++ . Previous studies using a polyimide membrane for ^20 Ne/ ^40 Ar separation were limited by the drawbacks of elastomeric O-rings to support the membrane, such as low-temperature intolerance, outgassing, and the need to endure environmental conditions during the launch and before/after landing on Mars. This study proposes a new method employing a metal C-ring to secure a 100 μ m polyimide sheet within vacuum flanges. Environmental tests, including vibration, shock, extreme temperatures, and radiation exposure, were conducted on the gas separation flanges. Pre- and post-test analyses for He, Ne, and Ar demonstrated the membrane-flange system’s resilience. Gas permeation measurements using terrestrial air effectively permeated ^4 He and ^20 Ne, while reducing ^40 Ar by more than six orders of magnitude. This study achieved a

BackgroundIt is known that patients reporting chronic pain often experience trauma or post-traumatic stress disorder (PTSD) and tend to be more difficult to treat. Attention deficit hyperactivity disorder (ADHD), a neurodevelopmental disorder, is frequently associated with chronic pain. Furthermore, patients diagnosed with ADHD are more likely to encounter trauma and develop PTSD because of their inattentive and impulsive tendencies. There are reports stating that atomoxetine (ATX), a selective noradrenaline reuptake inhibitor for ADHD, is effective in patients diagnosed with PTSD and ADHD. However, there have been no reports on cases of comorbid PTSD and ADHD with chronic pain, and ATX’s potential in improving chronic pain coexisting PTSD. Furthermore, no reports have evaluated patient cerebral blood flow in conjunction with the course of treatment with ATX for chronic pain.Case reportIn this study, we reported a case where ATX improved chronic pain with PTSD and improved cerebral blood flow. The patient was a 56-year-old woman exhibiting chronic pain with PTSD, resulting from 6 years of severe domestic violence from her common-law husband. She had no history of ADHD diagnosis, but through aggressive screening, comorbid ADHD was diagnosed. When treated with ATX, there were significant improvements in her pain, quality of life, anxiety, depression, catastrophic thoughts, and cerebral blood flow. As a result, she could resume work after 11 years.ConclusionThe study showed that chronic pain with PTSD may be comorbid with ADHD. Moreover, we found that ATX can improve chronic pain with PTSD and cerebral blood flow. Aggressive screening of ADHD is important because once the diagnosis of comorbidity is confirmed, an ideal ADHD treatment can be selected. Therefore, based on the results of this study, ATX may be a candidate for treatment for cases of chronic pain with PTSD and ADHD.

Abstract The density of the solar wind plasma near the Earth’s magnetosphere sometimes decreases to only several per cent of the usual value, and such density extrema result in a significant reduction of the dynamic pressure and Alfvén Mach number ( $$M_A$$ M A ) of the solar wind flow. While a symmetric expansion of the Earth’s magnetosphere by the low dynamic pressure was assumed in previous studies, a global magnetohydrodynamic (MHD) simulation study predicted a remarkable dawn-dusk asymmetry of the magnetospheric shape under low-density solar wind and Parker-spiral interplanetary magnetic field (IMF) configuration. Here, we present observations consistent with the asymmetric deformation of the magnetosphere under low- $$M_A$$ M A solar wind and Parker-spiral IMF conditions, focusing on the significant expansion of the dawn-flank magnetosphere detected by the Geotail spacecraft. A global MHD simulation reproduced the dawnward expansion of the near-Earth magnetosphere, which was consistent with the observation by Geotail. The solar wind flow had a non-negligible dusk-to-dawn component and partly affected the dawnward expansion of the magnetosphere. Local, roughly Alfvénic sunward acceleration of magnetosheath ions at the dawn flank magnetopause suggests magnetosheath plasma entry into the magnetosphere through open field lines generated by magnetic reconnection at the dayside magnetopause. At the same time, Cluster 1 and 3, located near the southern polar cusp, also detected continuous antisunward ion jets and occasional sunward jets, which are consistent with the occurrence of magnetic reconnection near the southern cusp. These observations suggest that enhanced plasma acceleration at the dayside magnetopause operates under the low- $$M_A$$ M A solar wind and Parker spiral IMF conditions and that plasma influx across the dawnside magnetopause is at work under such a low- $$M_A$$ M A condition. These results can be helpful in understanding interactions between low- $$M_A$$ M A solar/stellar winds and celestial objects, such as inner planets and exoplanets. Graphic Abstract

Abstract Background Squatting exercises are commonly used in rehabilitation for knee joint disorders; in these exercises, control of knee extensor moment is important to enhance training effects and to avoid adverse effects. Ankle dorsiflexion and trunk flexion are widely used to reduce knee extensor moments during squatting, but the increased load on the low back is a concern. The purpose of this study was to determine whether the anterior–posterior (AP) center-of-pressure (COP) position and the AP-COP position in combination with ankle dorsiflexion and trunk flexion angles can predict the contribution of the knee extensor moment during double-leg squatting. Methods Twenty-eight healthy individuals (14 female and 14 male participants, age 22.8 ± 1.3 years) performed three sets of five consecutive double-leg squats. Kinematics and kinetics were analyzed using a three-dimensional motion analysis system with force plates. Univariate and multivariate regression analyses were performed to predict the contribution of the knee extensor moment (% total support moment) from AP-COP position, ankle dorsiflexion, and trunk flexion. Results The AP-COP position was a significant predictor of the knee extensor moment contribution (R 2 = 0.168, P = 0.030). Multivariate analysis showed that the ankle dorsiflexion angle (ΔR 2 = 0.561, β = 0.842) and AP-COP position (ΔR 2 = 0.296, β = − 0.499) predicted the knee extensor moment contribution (model R 2 = 0.857, P

Key Clinical Message Persistent idiopathic facial pain (PIFP) and attention‐deficit/hyperactivity disorder (ADHD) may coexist and can be improved with ADHD medications. Thus, clinicians should screen for ADHD by a multidisciplinary approach when treating PIFP and differentiate between other odontogenic disorders. Abstract We report a case of a woman with persistent idiopathic facial pain (PIFP) and attention‐deficit/hyperactivity disorder (ADHD) that markedly improved with the administration of a combination of aripiprazole (APZ) and methylphenidate (MP) treatment. Screening for ADHD and administration of APZ and/or MP may be considered in treating PIFP.

IntroductionOral dysesthesia is a disease characterized by pain and/or abnormal sensations in the oral region, without any organic abnormality. Its symptoms include pain, and it is considered to be a disorder associated with idiopathic oral-facial pain. It is also known that idiopathic oral-facial pain tends to coexist with chronic musculoskeletal pain, including low back pain, even before its onset. Such coexisting idiopathic pain conditions are also called chronic overlapping pain conditions (COPCs). In general, COPCs are often refractory to treatment. Recently, it has been reported that attention deficit hyperactivity disorder (ADHD) is associated with many COPCs, such as pain in the facial and lower back regions and so on. However, there are no reports of (1) ADHD as a comorbidity with oral dysesthesia (OD) or (2) of the therapeutic effects of ADHD medications or dopamine agonists on low back pain and OD or an (3) evaluation of cerebral blood flow over time after treatment with these medications for OD and low back pain.Case PresentationIn this study, we report the case of an 80-year-old man with OD and chronic low back pain that persisted for more than 25 years. His OD and chronic back pain were refractory to standard treatment, prevented him from continuing work, and tended to be exacerbated by conflicts in his relationship with his son. In recent years, ADHD has often been found to be comorbid with chronic pain, and ADHD medications have been reported to improve chronic pain as well. The patient was confirmed to have undiagnosed ADHD and was treated with the ADHD medication atomoxetine and dopamine agonist pramipexole, which dramatically improved his OD, chronic back pain, and cognitive function. Furthermore, along the course of treatment, there was improvement in cerebral blood flow in his prefrontal cortex, which was thought to reflect improved function in the region. Consequently, he was able to resume work and improve his family relationships.ConclusionTherefore, in the cases of ODs and COPCs, screening for ADHD and, if ADHD is diagnosed, ADHD medications or dopamine agonists may be considered.

Accuracy validation of gait analysis using pose estimation with artificial intelligence (AI) remains inadequate, particularly in objective assessments of absolute error and similarity of waveform patterns. This study aimed to clarify objective measures for absolute error and waveform pattern similarity in gait analysis using pose estimation AI (OpenPose). Additionally, we investigated the feasibility of simultaneous measuring both lower limbs using a single camera from one side. We compared motion analysis data from pose estimation AI using video footage that was synchronized with a three-dimensional motion analysis device. The comparisons involved mean absolute error (MAE) and the coefficient of multiple correlation (CMC) to compare the waveform pattern similarity. The MAE ranged from 2.3 to 3.1° on the camera side and from 3.1 to 4.1° on the opposite side, with slightly higher accuracy on the camera side. Moreover, the CMC ranged from 0.936 to 0.994 on the camera side and from 0.890 to 0.988 on the opposite side, indicating a “very good to excellent” waveform similarity. Gait analysis using a single camera revealed that the precision on both sides was sufficiently robust for clinical evaluation, while measurement accuracy was slightly superior on the camera side.

Abstract Background Lateral trunk obliquity during landing is a characteristic of anterior cruciate ligament (ACL) injuries in female athletes and affects their knee and hip kinetics and kinematics. However, it is unclear whether these effects differ between females and males. The purpose of this study was to compare the effects of lateral trunk obliquity on knee and hip kinetics and kinematics in females and males during single-leg landing. Methods Eighteen female (aged 22.1 ± 1.5 years) and 18 male participants (aged 21.8 ± 1.1 years) performed single-leg landings under two conditions: (1) without any instructions about trunk position (natural) and (2) with leaning their trunks laterally 15° from the vertical line (trunk obliquity). The kinetics and kinematics of their hip and knee were analyzed using a three-dimensional motion analysis with a force plate. Two-way repeated-measures ANOVA (sex × trunk obliquity) and Bonferroni pairwise comparisons were conducted. Results The trunk obliquity angle at initial contact was significantly greater in the trunk-obliquity landing condition than in the natural landing condition (natural 4.0 ± 2.2°, trunk-obliquity 15.1 ± 3.6°, P

Energetic electron densities in the radiation belt increases during geomagnetic storms. Here, the authors show oblique whistler mode waves enhance electron losses and create strong fluxes of about 100 keV electrons precipitating into the atmosphere, that should be considered in radiation belt models.

Abstract The mass spectrum analyzer (MSA) will perform in situ observations of ions and magnetic fields around Phobos as part of the Martian Moons eXploration (MMX) mission to investigate the origin of the Martian moons and physical processes in the Martian environment. MSA consists of an ion energy mass spectrometer and two magnetometers which will measure velocity distribution functions and mass/charge distributions of low-energy ions and magnetic field vectors, respectively. For the MMX scientific objectives, MSA will observe solar wind ions, those scattered at the Phobos surface, water-related ions generated in the predicted Martian gas torus, secondary ions sputtered from Phobos, and escaping ions from the Martian atmosphere, while monitoring the surrounding magnetic field. MSA will be developed from previous instruments for space plasma missions such as Kaguya, Arase, and BepiColombo/Mio to contribute to the MMX scientific objectives.

Abstract John Fitzgerald Kennedy (JFK), the 35th President of the USA, had chronic low back pain deemed to be centralized pain. Reportedly, attention‐deficit/hyperactivity disorder (ADHD) could associate with centralized pain. Based on his biographies, JFK could have had ADHD, a plausible cause of pain that afflicted him.

Chronic pain has recently been associated with developmental disorders [autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)]. Regarding chronic pain in adulthood, fibromyalgia, migraine, and chronic low back pain have been associated with ADHD. The ICD-11 disease classification categorizes these pain diseases as chronic primary pain, suggesting high comorbidity with developmental disorders in chronic primary pain. Atypical odontalgia (AO) is a persistent tooth pain that occurs in the absence of any of the usual dental causes, most of which are triggered by dental treatment. Conditions characterized by tooth pain with no apparent cause are also classified as chronic primary pain. Approximately half the patients with AO are diagnosed with psychiatric disorders; the most common are depression (15.4%) and anxiety disorders (10.1%). However, there are no reports on neurodevelopmental disorders comorbid with AO. In the present study, we report a case of a 46-year-old man with numerous complaints (e.g., occlusal instability, difficulty eating, difficulty speaking), who took work leave due to worsening of his symptoms after periodontal scaling (“gingival recession” and “aggressive periodontal treatment”) and frequently expressed dissatisfaction and anger at the hospital, making the dental treatment difficult. After a referral to a psychiatrist specializing in chronic pain, AO and previously undiagnosed comorbidity of ASD and ADHD were confirmed. Atypical antipsychotic risperidone for ASD irritability and an ADHD medication, atomoxetine dramatically reduced anger, pain, anxiety, depression, and pain catastrophizing thoughts, leading to reduced obsession with his symptoms and less frequent complaints. After risperidone (1 mg/day) + atomoxetine (120 mg/day) were ultimately prescribed after adjustment, he was able to return to work 226 days after initiation of psychiatric treatment. Recent studies show that comorbidity of developmental disorders in patients with chronic pain is likely to be undetected. Clinicians should include screening for ASD and ADHD not only in cases of fibromyalgia, migraine, and chronic low back pain, but also in orofacial pain such as AO and other treatments for chronic primary pain. For patients diagnosed with ASD or ADHD, an effective drug therapy for ASD and ADHD should be considered.