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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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.

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Trigeminal Neuralgia Awareness Day

October 7, 2014 is Trigeminal Neuralgia Awareness Day.

I have been suffering from severe and constant facial pain for approximately 3 years.  It has been diagnosed as many things, one of which is Trigeminal Neuralgia.  Because I have received so many different diagnoses for this pain, and have one Neurologist who changed his diagnosis after several months of treatment, I am somewhat uncertain as to what I really have or who I should believe.  I usually say that I have a chronic facial pain syndrome, but most likely what I have is Atypical Trigeminal Neuralgia, which is sometimes called Type 2 Trigeminal Neuralgia (TN2) or ATN.

Since today is Trigeminal Neuralgia Awareness Day, I wanted to share some facts about this life altering condition.

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The following information is from the National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov).

What is trigeminal neuralgia?

Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode.  These attacks can occur in quick succession, in volleys lasting as long as two hours.  The “atypical” form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1.  Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.

The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. The ophthalmic, or upper, branch supplies sensation to most of the scalp, forehead, and front of the head. The maxillary, or middle, branch stimulates the cheek, upper jaw, top lip, teeth and gums, and to the side of the nose. The mandibular, or lower, branch supplies nerves to the lower jaw, teeth and gums, and bottom lip. More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time (called bilateral TN). Continue reading

Pain Scale

Everyone has likely been exposed to the pain scale at some point in their life.  You know, the scale from one to ten, that you are supposed to use to explain your pain level to medical professionals.

For those who live with chronic pain, we quickly become VERY familiar with this scale.  We see it in hospitals, in doctor’s offices, and those in pain management see and use it on a very regular basis.

The pain scale is important because it is how we explain the severity of our pain to doctors and nurses and hopefully, if used correctly, it helps to guide them in determining appropriate treatment options.

The problem with the pain scale is that there are many different versions and the scale in and of itself is very subjective.  What one patient might rate as a 6, another might rate as a 3.  That is because most people don’t really have a good understanding of what each level means.  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