Impact of ADHD on Pain and Chronic Pain Management

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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 to back their hypotheses:

  • Abnormal sensory processing in ADHD and pain transmission[3]
  • Pychiatric disorders such as anxiety and depression occurrence with diagnosed ADHD[4]
  • Areas of the brain that show pathological changes in ADHD are also responsible for processing pain pathways[5][6]In addition see Chronic Pain and the Brain
  • Neuro-inflammation shows promising link between ADHD and pain.   neuro-inflammation is present in multiple psychiatric disorders and evidence in a 2017 systematic review suggests an association with ADHD[7]  Neuro inflammation is well established in its association with acute pain tissue healing and also 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 accomodate cognitive, emotional and psychiatric co-morbidities that may be present in the patient before you when utilizing Pain Neuroscience Education and Cognitive Functional Therapy approaches.
  • Be cognoscente of the fact that 20% of patients with ADHD are diagnosed by a psychiatrist[10]-consider appropriate referral process to a neuropsychiatrist

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

In a case study by Zain et. al.[11], methylphenidate improved the chronic pain symptoms in a 43 y/o male with newly diagnosed ADHD and a 15 year history of idiopathic pain was prescribed osmotic release oral system methylphenidate. He had abolishment of pain in 4 week and on a 7 year checkup had no reoccurrence of his pain symptoms and normal functional activity. In addition, ADHD symptoms improved with no stimulant addiction issues.

Resources[edit | edit source]

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 6 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.

[12]

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. ↑ 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.
  12. ↑ 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]
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