Impact of ADHD on Pain and Chronic Pain Management
Original Editor - Bruce Knudsen
Top Contributors - Bruce Knudsen, Kim Jackson and Mahbubur Rahman
Introduction[edit | edit source]
There is resent 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.
Pharmacological 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]
- ↑ 1.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Vanneste S, Song JJ, De Ridder D. Thalamocortical dysrhythmia detected by machine learning. Nature communications. 2018 Mar 16;9(1):1103.
- ↑ 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.
- ↑ Matsuda M, Huh Y, Ji RR. Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. Journal of anesthesia. 2019 Feb 20;33:131-9.
- ↑ 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.
- ↑ 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.
- ↑ 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]
- ↑ 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.