DEVELOPMENTAL PAIN AS AN EMBODIED EXPRESSION OF NEUROBIOLOGICAL ADAPTATION: DIFFERENCES BETWEEN CHILDHOOD AND ADOLESCENCE

A. Ascione, V. Alfano | Centro Anima Iris Pompei, Napoli, Italy

Introduction. Persistent pain in developmental age is increasingly recognized as a multidimensional condition arising from the interaction between neurobiological maturation, stress regulation, emotional development, and environmental experiences. Emerging evidence suggests that adverse relational experiences during early life may influence the development of neural systems involved in nociceptive processing, interoception, and pain modulation, contributing to vulnerability to chronic pain conditions. Exploring developmental differences between childhood and adolescence may provide clinically relevant insights for prevention and treatment.
Methods. An integrated narrative review was conducted examining evidence from developmental neuroscience, psychoneuroimmunology, attachment research, and pediatric pain medicine. Findings were compared with clinical observations derived from over twenty years of psychotherapeutic practice involving children and adolescents presenting recurrent pain symptoms and functional somatic disorders.
Results. Current evidence indicates that chronic exposure to relational stress, emotional neglect, and adverse childhood experiences may affect the maturation of the hypothalamic-pituitary-adrenal axis, autonomic nervous system regulation, neuroimmune functioning, and brain networks involved in emotional and pain processing. During childhood, when symbolic elaboration and emotional regulation capacities are still developing, these alterations are frequently associated with recurrent abdominal pain, headaches, and functional somatic symptoms. In this developmental phase, pain may represent an embodied expression of dysregulated stress responses and altered interoceptive processing. Adolescence constitutes a distinct neurodevelopmental stage characterized by synaptic remodeling, hormonal changes, increased limbic activation, and incomplete maturation of prefrontal regulatory systems. Within this context, early vulnerabilities may interact with developmental challenges, facilitating central sensitization processes and increasing the risk of pain chronification. Clinical manifestations frequently include chronic headaches, diffuse musculoskeletal pain, juvenile fibromyalgia, and persistent functional pain syndromes.
Conclusions. Persistent pain in developmental age should not be considered solely a sensory phenomenon but rather a dynamic neurobiological process shaped by the continuous interaction between body, brain, and relational environment. A developmental perspective suggests that pain may reflect adaptive neurobiological responses to chronic stress and relational dysregulation. Integrating developmental neuroscience, pain medicine, and early psychological interventions may improve identification of vulnerable individuals and contribute to preventing chronic pain trajectories across the lifespan.