Summary: A large-scale study of nearly 1,000 patients in Japan has uncovered a substantial overlap between attention-deficit/hyperactivity disorder (ADHD) traits and chronic pain. Adults referred to specialized pain centers were about 2.4 times more likely to show ADHD-related traits than expected in the general population.
The research indicates that ADHD does not appear to cause pain through a direct physical mechanism. Instead, ADHD-related traits amplify psychological drivers—such as anxiety, depression, and pain catastrophizing (persistent negative thoughts about pain)—which in turn intensify pain perception and make chronic pain harder to manage.
Key Facts
- Higher prevalence: Approximately 25% of patients with persistent chronic pain screened positive for significant ADHD-related traits—far above the estimated 3–7% prevalence in general adult populations.
- Indirect pathway: ADHD traits are linked to increased anxiety and depression, which lower pain tolerance and raise reported pain severity, rather than causing pain directly.
- Clinical oversight: Because many adults with ADHD remain undiagnosed, they may not respond well to conventional, primarily physical treatments for chronic pain. Routine screening for ADHD in pain clinics could guide more targeted care.
- Holistic treatment: The investigators recommend a comprehensive approach combining medication where appropriate with psychoeducation, cognitive behavioral therapy, and rehabilitation to address both neurodevelopmental traits and pain-related psychological factors.
Source: University of Tokyo
A new study led by researchers at the University of Tokyo examined nearly 1,000 adults visiting multidisciplinary pain centers across Japan and found a notable association between ADHD traits and persistent chronic pain.
Chronic pain is a long-lasting condition that often resists standard treatments and affects daily functioning for millions worldwide. Because pain reflects both physical and psychosocial influences, clinicians increasingly seek tailored, multidisciplinary strategies. One emerging line of investigation explores how neurodevelopmental traits such as ADHD and autism spectrum disorder (ASD) intersect with chronic pain.
Dr. Satoshi Kasahara and colleagues screened 958 patients who continued to experience chronic pain despite standard care. They found that screening positivity rates were 17.1% for ADHD and 4.4% for ASD. Importantly, ADHD symptoms—but not ASD symptoms—showed a strong association with higher reported pain intensity, including the subgroup reporting extremely severe pain (average numerical rating scores of 9–10).
Among those with the most severe pain, more than one quarter (27.4%) screened positive for ADHD. Statistical analyses showed that the relationship between ADHD symptoms and extreme pain weakened after accounting for anxiety, depression, and pain catastrophizing. Path analysis suggested that ADHD symptoms influence severe pain indirectly—primarily by increasing anxiety and depression, and through a combination of emotional distress and pain-related negative thinking.
These results reinforce the view that chronic pain is not purely physical: cognitive and emotional factors linked to ADHD may play a central role in how intensely pain is experienced. The study also highlights a potential gap in clinical recognition, since many adults with ADHD are undiagnosed and may present primarily for pain management rather than neurodevelopmental assessment.
Kasahara notes that routine screening for ADHD symptoms in pain clinics could help clinicians choose more effective treatment pathways. For patients whose pain does not respond to standard physical interventions, identifying ADHD-related traits can prompt strategies that calm the nervous system—such as cognitive behavioral therapy (CBT), structured rehabilitation programs that integrate exercise, and psychoeducation to improve self-awareness and daily functioning.
“In our clinical practice we often meet patients with chronic pain who show inattention, impulsivity, or emotional dysregulation—traits commonly associated with ADHD—and who do not respond to conventional treatments,” Kasahara said. “Recognizing these traits may open new avenues for care that combine medical, psychological, and rehabilitative approaches.”
The research team plans prospective and interventional studies to test whether identifying and treating ADHD in chronic pain patients can reduce pain severity and improve overall outcomes. They emphasize that interventions such as CBT, exercise-based rehabilitation, and psychoeducation may be as important as medication for many patients and that an integrated treatment plan is likely to be most effective.
Funding: This study was supported by the Health and Labor Sciences Research Grants, 19FG2001.
Key Questions Answered:
A: Many people with ADHD experience difficulties regulating emotions. When pain occurs, this can trigger persistent negative thought patterns and heightened worry that the pain will never end. These psychological states keep the nervous system activated, which can amplify how strongly pain is perceived in the brain.
A: If standard pain treatments are ineffective and you also experience symptoms such as inattention, impulsivity, or restlessness, screening for ADHD may be helpful. Identifying ADHD-related traits can shift the treatment focus from merely treating tissues to addressing emotional regulation and nervous system arousal—often through CBT and other psychological strategies.
A: This study did not test medications directly, so it cannot confirm medication effects on pain. However, the findings suggest that treating underlying ADHD—whether with medications, behavioral therapies, or both—might reduce anxiety and depression that contribute to pain, potentially making pain itself easier to manage.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by the editorial team.
- Additional context was added by staff to clarify clinical implications.
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 reflects both physical and psychosocial contributors and has been linked to symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, which symptom dimensions relate most strongly to pain severity and through which psychosocial pathways remained unclear.
This cross-sectional screening study enrolled 958 adult patients who presented with persistent chronic pain despite standard care at multidisciplinary pain centers in Japan. Screening positivity rates were 17.1% for ADHD and 4.4% for ASD. ADHD symptoms—but not ASD symptoms—were markedly associated with higher pain intensity and with cases of extremely severe pain (average numerical rating scale scores of 9–10).
Among patients experiencing extremely severe pain, 27.4% screened positive for ADHD. Hierarchical logistic regression showed the association between ADHD symptoms and extremely severe pain diminished after adjusting for anxiety, depression, and pain catastrophizing. Path analyses indicated that ADHD symptoms were indirectly linked to severe chronic pain primarily through anxiety and depression, and through a combined pathway of anxiety/depression plus pain catastrophizing.
In summary, ADHD symptoms were more strongly associated with pain severity than ASD symptoms in this population with persistent chronic pain, and emotional and cognitive factors appear to be key mediators. Routine screening for ADHD symptoms may therefore be essential for comprehensive management of severe chronic pain.