Impact of ADHD on Pain and Chronic Pain Management: Difference between revisions

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== Considerations for the clinician in pain and chronic management ==
== Considerations for the clinician in pain and chronic management ==


* Because of the many facets of ADHD, consider narrowing your focus and presentation to help accomodate cognitive, emotional and psychiatric co-morbidities that may be present in patient's with ADHD when utilizing [https://www.physio-pedia.com/Pain_Neuroscience_Education_(PNE)?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Pain Neuroscience Education] and [https://www.physio-pedia.com/Cognitive_Functional_Therapy?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Cognitive Functional Therapy] approaches.
* Because of the many facets of ADHD, consider narrowing your focus and presentation to help accommodate cognitive, emotional and psychiatric co-morbidities that may be present in patient's with ADHD when utilizing [https://www.physio-pedia.com/Pain_Neuroscience_Education_(PNE)?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Pain Neuroscience Education] and [https://www.physio-pedia.com/Cognitive_Functional_Therapy?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal Cognitive Functional Therapy] approaches.
* Be cognoscente of the fact that ''only'' 20% of patients with ADHD are diagnosed by a psychiatrist<ref>Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA. Adult ADHD: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884156/ Underdiagnosis of a Treatable Condition.] Journal of health service psychology. 2023 Feb;49(1):11-9.</ref>-consider an appropriate referral process to a neuropsychiatrist  
* Be cognoscente of the fact that ''only'' 20% of patients with ADHD are diagnosed by a psychiatrist<ref>Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA. Adult ADHD: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9884156/ Underdiagnosis of a Treatable Condition.] Journal of health service psychology. 2023 Feb;49(1):11-9.</ref>-consider an appropriate referral process to a neuropsychiatrist  
<blockquote>The following video has a very helpful section at the 66 minute mark where Dr. Larry Culpepper addresses identifying ADHD in primary care situations.  It has a short six question screening tool as well.  The rest of the video is very informative as well to educate how encompassing the effects of ADHD is on a patient's health.</blockquote>
<blockquote>The following video has a very helpful section at the 66 minute mark where Dr. Larry Culpepper addresses identifying ADHD in primary care situations.  It has a short six question screening tool as well.  The rest of the video is very informative as well to educate how encompassing the effects of ADHD is on a patient's health.</blockquote>
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[[Category:Pain]]
[[Category:Mental Health]]
[[Category:Conditions]]

Revision as of 02:27, 25 November 2023

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (25/11/2023)

Original Editor - Bruce Knudsen

Top Contributors - Bruce Knudsen, Kim Jackson and Mahbubur Rahman  

Introduction[edit | edit source]

There is recent evidence suggesting a relationship between Attention-Deficit/Hyperactive Disorder. These two conditions have been determined to have shared multifactorial origins[1][2]"At present, there are no established health care routines for examining psychiatric symptoms when investigating functional pain conditions in a somatic care setting, nor is there any knowledge of offering patients with ADHD or other neuro-psychiatric diagnoses adapted treatments for pain conditions[1]." There have been proposed and well documented studies showing the coexistence of abnormal pain perception and ADHD. Some of the studies are more theoretical or have low power. Several with in depth looks at neurophysiological comparisons and changes have been in vivo based studies. The following areas have more robust evidence:

  • Abnormal sensory processing in ADHD and pain transmission[3]
  • Psychiatric disorders such as anxiety and depression occur with chronic pain and ADHD[4]
  • Areas of the brain that show pathological changes in ADHD are also responsible for processing pain pathways[5][6](Additional resources at the Chronic Pain and the Brain page)
  • Neuro-inflammation is present in multiple psychiatric disorders and evidence in a 2017 systematic review suggests an association with ADHD[7]  and is well established in its association with acute pain tissue healing and as a trigger for chronic pain central sensitization[8][9](See Neurogenic Inflammation in Musculoskeletal Conditions for additional information on neuro inflammation and pain)

Considerations for the clinician in pain and chronic management[edit | edit source]

  • Because of the many facets of ADHD, consider narrowing your focus and presentation to help accommodate cognitive, emotional and psychiatric co-morbidities that may be present in patient's with ADHD when utilizing Pain Neuroscience Education and Cognitive Functional Therapy approaches.
  • Be cognoscente of the fact that only 20% of patients with ADHD are diagnosed by a psychiatrist[10]-consider an appropriate referral process to a neuropsychiatrist

The following video has a very helpful section at the 66 minute mark where Dr. Larry Culpepper addresses identifying ADHD in primary care situations. It has a short six question screening tool as well. The rest of the video is very informative as well to educate how encompassing the effects of ADHD is on a patient's health.

[11]

Pharmalogical medication for ADHD showing promising findings in chronic pain alleviation[edit | edit source]

In a case study by Zain et. al.[12], methylphenidate improved the chronic pain symptoms in a 43 y/o male with newly diagnosed ADHD. He had a 15 year history of idiopathic pain and was prescribed osmotic release oral system methylphenidate. The result was an abolishment of pain in 4 week, return of normal function with daily activities, and no reoccurrence of pain for 7 years. In addition, his ADHD symptoms improved with no stimulant addiction issues.


References[edit | edit source]

  1. ↑ 1.0 1.1 Kerekes N, Sanchéz-Pérez AM, Landry M. Neuroinflammation as a possible link between attention-deficit/hyperactivity disorder (ADHD) and pain. Medical Hypotheses. 2021 Dec 1;157:110717.
  2. ↑ Asztély K, Kopp S, Gillberg C, Waern M, Bergman S. Chronic pain and health-related quality of life in women with autism and/or ADHD: a prospective longitudinal study. Journal of pain research. 2019 Oct 18:2925-32.
  3. ↑ Panagiotidi M, Overton PG, Stafford T. The relationship between ADHD traits and sensory sensitivity in the general population. Comprehensive psychiatry. 2018 Jan 1;80:179-85.
  4. ↑ Karaş H, Çetingök H, İlişer R, Çarpar E, Kaşer M. Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact. International Journal of Psychiatry in Clinical Practice. 2020 Sep 1;24(3):257-63.
  5. ↑ Tajima-Pozo K, Yus M, Ruiz-Manrique G, Lewczuk A, Arrazola J, Montañes-Rada F. Amygdala abnormalities in adults with ADHD. Journal of attention disorders. 2018 May;22(7):671-8.
  6. ↑ Vanneste S, Song JJ, De Ridder D. Thalamocortical dysrhythmia detected by machine learning. Nature communications. 2018 Mar 16;9(1):1103.
  7. ↑ Anand D, Colpo GD, Zeni G, Zeni CP, Teixeira AL. Attention-deficit/hyperactivity disorder and inflammation: what does current knowledge tell us? A systematic review. Frontiers in psychiatry. 2017 Nov 9;8:228.
  8. ↑ Matsuda M, Huh Y, Ji RR. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. Journal of anesthesia. 2019 Feb 20;33:131-9.
  9. ↑ Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology. 2018 Aug 1;129(2):343-66.
  10. ↑ Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA. Adult ADHD: Underdiagnosis of a Treatable Condition. Journal of health service psychology. 2023 Feb;49(1):11-9.
  11. ↑ Adult ADHD: Impact on Chronic Conditions and Adherence to Medical Recommendations Available from: https://www.youtube.com/watch?v=WbWe-_jZEeQ [last accessed 11/23/2023]
  12. ↑ Zain E, Sugimoto A, Egawa J, Someya T. Case report: Methylphenidate improved chronic pain in an adult patient with attention deficit hyperactivity disorder. Frontiers in Psychiatry. 2023 Mar 10;14:1091399.
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