Summary: A large-scale study of nearly 1,000 patients in Japan has revealed a significant overlap between ADHD-related traits and chronic pain. The research found that adults seeking help at specialized pain centers are 2.4 times more likely to exhibit ADHD traits than the general population.
The findings suggest that ADHD influences pain not through a direct physical mechanism, but by intensifying psychological “multipliers” like anxiety, depression, and “pain catastrophizing” (negative thought patterns), which make chronic pain harder to treat.
Key Facts
- Higher Prevalence: Roughly 25% of the chronic pain patients studied showed significant ADHD traits, a rate far higher than the estimated 3-7% found in the general adult population.
- The Indirect Pathway: ADHD traits do not cause pain directly; instead, they appear to drive increased levels of anxiety and depression, which in turn lower pain tolerance and increase pain severity.
- Clinical Oversight: Because many adults with ADHD remain undiagnosed, they often fail to respond to conventional physical pain treatments. Screening for ADHD in pain clinics could unlock more effective, tailored care.
- Holistic Treatment: The researchers advocate for a “comprehensive approach” that combines medication with psychoeducation and behavioral therapy to help patients manage both their neurodevelopmental traits and their pain perception.
Source: University of Tokyo
A new study, led by researchers from the University of Tokyo, involving nearly 1,000 patients in Japan suggests that attention deficit hyperactivity disorder (ADHD)-related traits may be associated with and may contribute to chronic pain.
The connection seems solid but indirect: ADHD-related traits appear to impact how people perceive pain through increased anxiety, depression and negative thought patterns. This research presents potential avenues for new tailored treatments and rehabilitation for those with ADHD and chronic pain.
Chronic pain is long-lasting pain that evades common treatments and affects millions of people around the world. Among the issues relating to it is the fact that pain is not a purely physical phenomenon, so treatments may involve multiple modes of intervention and need to be highly tailored to an individual.
To aid this way of treating chronic pain, researchers look at it from different angles, including how specific groups of people may face it. This has led to some research on potential impacts of neurodevelopmental conditions such as ADHD.
“In our latest study, we looked at patients with severe chronic pain who were being treated at specialized pain centers across Japan, and examined how often ADHD- and autism-related traits were present in this population,” said Dr. Satoshi Kasahara from the Department of Anesthesiology and Pain Relief Center at the University of Tokyo Hospital.
“We found that ADHD-related traits were more common in these patients than in the general population, about 2.4 times higher. These traits were also closely linked to pain severity, as well as to psychological factors such as anxiety, depression and negative ways of thinking about pain.”
Their findings support the idea that pain is not merely physical in nature, but that mental and neurological traits may play a bigger role than thought. There’s also a strong implication that ADHD has been overlooked in this context.
Many adults with ADHD are undiagnosed and don’t often get diagnosed even when attending diagnosis for things like chronic pain. Kasahara and his team think that their research could be useful for clinicians, as a positive or negative ADHD diagnosis may help narrow down avenues for treatment for chronic pain patients.
“This research began from everyday clinical experience. In our practice, we frequently encounter patients with chronic pain who do not respond well to conventional treatments. Among these patients, many show characteristics commonly seen in ADHD, such as inattention, hyperactivity or impulsivity, and difficulties with emotional regulation,” said Kasahara.
“This led us to consider whether ADHD-related traits might be more common in this population than previously recognized, and whether they could be contributing to the persistence and severity of pain.”
As researchers and clinicians, the team aim to move beyond simply identifying associations and wish to examine if and how treating ADHD can help reduce chronic pain. They are considering conducting prospective and interventional studies for this. Appropriately identifying and addressing ADHD in patients with chronic pain may also help improve a patient’s overall condition.
“For example, approaches such as cognitive behavioral therapy and rehabilitation programs that include exercise have been widely used, and are considered effective in improving anxiety, depression and negative ways of thinking about pain, which in turn can help reduce chronic pain,” said Kasahara.
“In addition, some patients with ADHD-related traits may not fully recognize these traits themselves, and this can contribute to difficulties in daily life and interpersonal relationships. In such cases, psychoeducation, helping patients understand their own characteristics and learn how to better manage their behavior, can also play an important role.
“These kinds of approaches may be just as important as medication, and a comprehensive approach that combines medical, psychological and rehabilitative care is likely to be the most effective.”
Funding: This research was funded by the Health and Labor Sciences Research Grants, 19FG2001.
Key Questions Answered:
A: ADHD is often accompanied by difficulties in emotional regulation. When someone with ADHD traits experiences pain, they may be more prone to “negative thought patterns”, constant worrying that the pain will never end. This mental state keeps the nervous system on high alert, physically amplifying the sensation of pain in the brain.
A: If you find that traditional pain medications aren’t working and you also struggle with inattention, impulsivity, or restlessness, it might be worth a screening. Identifying these traits can help doctors shift from “fixing a joint” to “calming the nervous system” through cognitive behavioral therapy (CBT).
A: While this study didn’t test medications directly, it suggests that addressing the underlying ADHD, whether through medication or behavioral strategies—can reduce the anxiety and depression that feed chronic pain, potentially making the pain itself more manageable.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this ADHD and pain research news
Author: Rohan Mehra
Source: University of Tokyo
Contact: Rohan Mehra – University of Tokyo
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Chronic Pain: A Study in Japanese Pain Centers” by Satoshi Kasahara, Shuichi Aono, Kozue Takatsuki, Shin-Ichi Niwa & Shoji Yabuki. Scientific Reports
DOI:10.1038/s41598-026-45300-y
Abstract
Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Chronic Pain: A Study in Japanese Pain Centers
Chronic pain is influenced by physical and psychosocial factors and associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); however, the specific symptom dimension related to pain severity and the underlying psychosocial pathways remain unclear.
This cross-sectional screening study included 958 adult patients with persistent chronic pain despite standard care at their initial visit to multidisciplinary pain centers (Japan). Screening positivity rates were 17.1% for ADHD and 4.4% for ASD. ADHD symptoms, but not ASD symptoms, were considerably associated with higher pain intensity and extremely severe pain [average numerical rating scale score: 9–10].
Among patients with extremely severe pain, 27.4% were screened positive for ADHD. Hierarchical logistic regression analyses revealed that the association between ADHD symptoms and extremely severe pain was attenuated after adjustment for anxiety/depression and pain catastrophizing.
Path analyses further indicated that ADHD symptoms were indirectly associated with severe chronic pain through anxiety/depression alone or through anxiety/depression combined with pain catastrophizing.
Thus, ADHD symptoms are more strongly associated with pain severity than ASD symptoms in patients with persistent chronic pain, and emotional and cognitive factors may play a key mediating role.
Screening for ADHD symptoms is crucial for comprehensive management of severe chronic pain.
