Chronic Pain Linked to Attention-Deficit Disorder

ADHD word Attention Deficit Hyperactivity Disorder on magnifying glass and human brain on white background

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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This infuriates me on so many levels!!!  😡 

My husband’s pharmacy was robbed several months ago, but luckily the pharmacist had a gun, so he successfully defended himself and his business. Now another pharmacy was robbed in my hometown!  It is only a mile or two from my place of employment. 

WTF is wrong with people???

I’m sure the suspects are likely addicts or dealers, who don’t realize or care that commiting foolish acts like this, just helps to “confirm” the public’s inaccurate beliefs about pain medications and the increasing inhumane discrimination against chronic pain patients.  

It creates even more reasons for the government to continue the never-ending, FAILED, “war on drugs” which creates endless problems for those who truly NEED narcotics and find that obtaining adequate pain relief is becoming more and more difficult (or impossible) for legitimate chronic pain patients.

If the robbers were not addicts or dealers, it could be someone in desperate pain without access to the treatment that they need.  Either way, the situation is tragic and everyone loses.

http://5newsonline.com/2015/08/19/fayetteville-police-investigate-after-pharmacy-is-robbed/

Doctor Appointment #Infinity

Today I had a doctor appointment. Since I started blogging, I haven’t posted much about our doctor appointments but I think I should start, as they are part of our chronic pain journey which is what this blog is really about. It wasn’t exactly the way that I had planned on spending my day off, but since Veteran’s Day is a holiday where mainly only government employees are off work and I’m desperately trying to miss as little work as possible, I decided to schedule an appointment today.

Continue reading

Well, so far, this week’s score is 2:1 and Endometriosis is in the lead.

Yesterday I had the worst flare-up that I have had in years.  I woke up in horrible pain, so I sent an e-mail to work letting them know that I would be a couple of hours late.

I took my meds, sat on the couch, drinking coffee and smoking cigarettes, waiting for the meds to kick in.  As far as I could tell, they never did.

The pain continued to get worse, so I sent another e-mail telling my co-workers what was going on and that I would try to work the 2nd half of the day.  This was very troubling to me, as my boss likes to take spur of the moment road trips and had hit the road the day before so I knew that he would not be in the office.  For that reason, I had planned on going to work no matter what, but this situation was out of my control.  I could hardly walk or even move without moaning in pain, let alone drive and function at my workplace.

Luckily I had my laptop with me and let everyone know that I could perform any essential functions from home, if anything urgent came up.

Within the hour things got even worse.  Continue reading

Terrified

For the past several weeks, my anxiety has been spiraling out of control.  I have suffered from severe anxiety for most of my life; even as a child but back then I didn’t understand what it was, how to describe it, or that it wasn’t “normal.”

It was in my early twenties that I began suffering from debilitating panic attacks, which often landed me in urgent care clinics in fear that I was having a heart attack or worse.

After many doctor visits and a cardiology work-up, it was determined that my heart and lungs were basically healthy with the exception of trace mitral regurgitation (an early/mild form of mitral valve prolapse, where some of the blood that is supposed to pump out of the heart actually goes back in through the “exit”) which often causes sinus tachycardia.  Those things are part of the medical component which predisposed me to anxiety and panic attacks.

When I could not tolerate the beta blockers prescribed by my cardiologist to control my incredibly high heart rate, I started to do some research on my own and discovered some literature about panic disorder.  The symptoms include intense uncontrollable/unexplainable fear, a sense of impending doom, high heart/pulse rate, difficulty breathing, sweating, feeling as if you might faint or in some cases actually fainting, chest pain, hyperventilation, among other various symptoms.

I immediately knew that I had this condition and within a few weeks I was diagnosed with it. Continue reading

Medication Increase

Here we go again … I’m back on the medication roller-coaster and I really hate this ride.  About three hours ago, I started an increased dosage of my strongest long-acting medication.  I can already feel the side-effects, so I know this isn’t going to be fun.  This isn’t like one of those medications that you can take a partial dose of to see how it affects you and then not take it again if you don’t react well.  This is a 3 day commitment to the new dosage and there is no going back.  I shouldn’t drive during this time and I’m scared to sleep so I will just sit here.  Maybe watch some TV and work on my blog, unless I start feeling too sick to do those things.  I’m one of those people who is always cold.  I keep the thermostat set on 75 degrees or higher most days.  Not now though.  This medication makes me hot, sweaty, and uncomfortable.   I keep turning the A/C down more and more but it makes no difference.  The heat isn’t coming from the air around me, it’s some sort of weird side effect from the higher dosage of medication.  I know this well because when it comes to side effects, I get them all.  I have a heightened sensitivity to my body and I notice even the most subtle changes.  I’ve been through this before.  Hell, I should be a professional by now but it’s hard to get used to living like this.  Knowing that I rely on so many medications to get me through each day and help me cling to whatever thread of normalcy is left in my life.  It’s hard but it’s also necessary because I am a fighter and I will not give up;  I can’t.  Will it be like this forever?  I don’t know.  It very well could unless I encounter remission or a cure.   Continue reading