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.

Access the original article here: 

Advertisements

Depression & Our Anniversary

I know the title of this blog post may seem strange.  There is really no connection between the two words except that they are both present and on my mind.

Today is our 6th wedding anniversary.  Billy and I have been together for 11 years now and our love is strong.  We have been through challenges that would be hard to imagine and many that no one knows about except for us.  Things that would test and destroy the most solid relationship but somehow our love has always pulled us through and prevailed.  I am so thankful for my husband and the unconditional love that we share.

This should be a joyous day but I cried all the way to work.  Yesterday and the day before, I cried all the way home.  Last night I sat and cried on the couch but I don’t think Billy noticed.  He has his own overwhelming struggles to deal with and I tried not to make it obvious.  Throughout my years of participation in online chronic pain, Trigeminal Neuralgia/Facial Pain, Endometriosis, and PCOS support groups, I have read and been acclimated to the very real link between chronic pain and depression.  I knew it could happen and the likelihood that it would is very high.  I have watched my husband struggle with it for years, even before the wreck and his botched surgery, but so much more afterwards.  It has been ripping him apart for what seems like forever and it appears to finally be taking hold of me.  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