CHRONIC pain severity may be influenced by underlying neurodevelopmental symptoms, with new research showing that patients with ADHD traits were more likely to report extreme pain levels, highlighting the importance of broader psychological assessment in pain management.
Exploring Neurodevelopmental Factors in Chronic Pain
Chronic pain is shaped by both biological and psychosocial influences, yet the contribution of attention-deficit/hyperactivity disorder and autism spectrum disorder symptoms has not been fully defined. Investigators examined how these symptom dimensions relate to chronic pain severity and whether psychological pathways such as anxiety, depression, and catastrophising explain these associations.
Cross-Sectional Study of Chronic Pain Patients in Japan
This cross-sectional screening study included 958 adults presenting with persistent chronic pain despite standard care at multidisciplinary pain centres in Japan. Screening tools assessed symptoms of ADHD and autism spectrum disorder at initial consultation. Primary outcomes were associations between symptom positivity and pain severity measured by numerical rating scale scores. Secondary outcomes included mediation pathways involving anxiety, depression, and pain catastrophising.
ADHD Symptoms Show Stronger Link to Chronic Pain Severity
Screening positivity rates were 17.1% for ADHD and 4.4% for autism spectrum disorder. The results revealed that ADHD symptoms, but not autism spectrum disorder symptoms, were associated with higher chronic pain intensity and extremely severe chronic pain (defined as numerical rating scale scores of 9 to 10). Among patients with extremely severe chronic pain, 27.4% screened positive for ADHD symptoms. Hierarchical logistic regression showed that the association between ADHD symptoms and extremely severe chronic pain was attenuated after adjustment for anxiety and depression and pain catastrophising. Path analyses demonstrated indirect associations between ADHD symptoms and severe chronic pain mediated by anxiety and depression alone or combined with catastrophising.
Implications for Managing Severe Chronic Pain
These findings suggest that chronic pain care may benefit from screening for ADHD symptoms alongside psychological assessment. Addressing anxiety, depression, and maladaptive coping may reduce pain burden in affected patients. Further research should confirm causality and evaluate whether targeted ADHD interventions improve outcomes in chronic pain populations.
Reference
Kasahara S et al. Attention-deficit/hyperactivity disorder and autism spectrum disorder in chronic pain: a study in Japanese pain centers. Sci Rep. 2026;16:10544.
Featured image: Goffkein on Adobe Stock
