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](see additional resources on the Chronic Pain and the Brain page)
  • Neuroinflammation 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 sensitisation[8][9](See Neurogenic Inflammation in Musculoskeletal Conditions for additional information on neuroinflammation and pain)

Responsibilities of the different providers on the multidisciplinary team[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 patients with ADHD when utilising Pain Neuroscience Education and Cognitive Functional Therapy approaches.

Physical therapist[edit | edit source]

To encompass the shared presentation of ADHD and Pain or ADHD and Chronic Pain physical therapists may use a variety of therapeutic approaches:

  • A mechanical assessment to evaluate movement baselines and needs for improved mobility for pain modulation or abolishment to alleviate shared psychiatric symptoms between ADHD and acute pain or chronic pain such as unrealistic fear about movement, anxiety of re-injury or not being able to return to work, utilising treatment time to teach functional movements
  • Manual therapy is a commonly used therapeutic approach to manage ADHD symptoms with pain and or chronic pain symptoms to promote relaxation, pain alleviating functional mobility
  • [[Pain Neuroscience Education (PNE)#:~:text=PNE serves as,group.[7]|Pain neuroscience education]] to teach good and bad pain and just because something is hurting when you are doing it such as an exercise or functional movement it doesn't mean it is harmful. A patient dealing with ADHD needs the the assurance that the activity and exercise they are doing to help anxiety and depression may cause some discomfort , this is normal as just one example of the benefit of PNE for ADHD. Helping patients process through the pain and ADHD via PNE may show benefits concurrently to these diagnoses.
Occupational Therapist[edit | edit source]
  • Utilise a pain journal with a patient suffering these symptoms to help the ADHD patient process through the emotions and the fears and anxiety they experience along with what is triggering episodes of persistent pain
  • Educate the patient on how poor sleep can increase inflammatory levels that are present in ADHD and persistent pain. Providing education on sleep health and maximising their ability to experience the most restful sleep possible for benefits patients struggling with ADHD with pain or chronic pain
Neuropsychiatrist[edit | edit source]
  • Responsible for diagnosis of ADHD and needs for pharmacological therapeutics that would most likely alleviate ADHD symptoms but possibly assist in persistent pain symptoms
  • Referrals as indicated to psychological counseling for talk therapy management for ADHD while considering the impact of ADHD on the patient's persistent pain

Additional considerations[edit | edit source]

  • 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 are on a patient's health.

[11]

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. ↑ 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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