By Pauline Anderson via Medscape
September 11, 2015
LAS VEGAS — More than a third of patients with chronic pain may have attention-deficit disorder (ADD), a small pilot study suggests.
The findings should encourage more doctors to have a high degree of suspicion of ADD in nonadherent patients with central pain, said author Forest Tennant, MD, Intractable Pain Management, West Covina, California.
“I think this is a nice new little advance in how to take care of people with pain.” He presented the findings here during PAINWeek 2015.
For the study, 45 consecutive patients with chronic pain attending a treatment clinic completed a 16-item questionnaire. The questions were directed at whether the patient had deficiencies in concentration, attention, distractibility, impulsivity, reading and retention, coordination, temper, and short-term memory.
A positive answer to five or more questions was considered to indicate the presence of ADD.
Results showed that 37.8% of the patients met these criteria for ADD.
Most patients with centralized pain have hyperarousal of the autonomic nervous system. “First off, they become deficient in catecholamine, which is one of the compounds that relieve pain,” explained Dr Tennant.
The pain causes a change in the sympathetic nervous system, which causes the ADD, he added. “So it puts you into this hyperactive state and at times it will also deplete dopamine both in the central nervous system and in the adrenal gland.”
The finding might help explain why some patients with pain have poor function in activities of daily living, said Dr Tennant.
“For years, I’ve seen the same kind of ADD in these patients that you see in children; they can’t remember half the time, they can’t concentrate,” he said. “It’s amazing how many of these patients actually quit reading or doing things, but they won’t tell you.”
A big problem for patients with pain is adherence issues, said Dr Tennant. “They don’t do what you tell them; they walk out of there and don’t follow instructions, and part of that is ADD.”
But once they start taking drugs for ADD, such as methylphenidate (eg, Ritalin), “their pain gets better and they can remember and concentrate.”
Dr Tennant stressed that this applies only to patients with centralized pain, who have inflammation in the nervous system, not those with arthritis or neuropathic pain. “These are the patients who have constant pain, pain that never goes away.”
He noted that the connection between pain and ADD is not new. “Physicians back in 1895 at hospitals in London said that if you have severe pain patients who need morphine, they also need a stimulant.”
Commenting on the study for Medscape Medical News, Jack LeFrock, MD, a pain specialist at Above and Beyond Pain Management and Laser Center, Clearwater, Florida, said the finding “makes sense.”
“I agree with him; I think he’s right on,” he said.
In his own practice, a “high percentage” of patients have ADD and are anxious, he added.
Dr LeFrock said he’s keen to study the topic further.
PAINWeek 2015. Poster 133. Presented September 10, 2015.
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