Summary: A large-scale study of nearly 1,000 patients in Japan found a clear connection between ADHD-related traits and persistent chronic pain. Adults referred to specialized pain centers were significantly more likely to display ADHD traits than the general population, and those traits were linked to greater pain severity largely through psychological pathways.
The research indicates that ADHD does not appear to increase pain through a direct physical mechanism. Instead, ADHD-related symptoms amplify psychological factors—such as anxiety, depression, and pain catastrophizing—that intensify pain perception and make chronic pain harder to treat.
Key Facts
- Higher prevalence among clinic patients: Screening identified ADHD traits in 17.1% of the chronic pain patients overall, and ASD in 4.4%. Among patients reporting extremely severe pain, 27.4% screened positive for ADHD—explaining earlier reports that rounded this subgroup to roughly 25%.
- Indirect pathway to worse pain: ADHD symptoms were strongly associated with higher pain intensity, but statistical analysis showed this relationship weakens after accounting for anxiety, depression, and pain-related negative thinking.
- Clinical implications: Because many adults with ADHD are undiagnosed, conventional treatments that target only physical causes may have limited effects. Routine screening for ADHD traits in pain clinics could guide more effective, individualized care plans.
- Holistic care recommended: The authors advocate integrating medication where appropriate with psychoeducation, cognitive behavioral therapy (CBT), and rehabilitative programs to address both neurodevelopmental traits and the emotional and cognitive drivers of pain.
Source: University of Tokyo
A new study led by researchers at the University of Tokyo evaluated nearly 1,000 adults seeking care at multidisciplinary pain centers across Japan and found a notable association between attention-deficit/hyperactivity disorder (ADHD) traits and chronic pain.
The study’s design focused on patients whose pain persisted despite standard care. By screening for neurodevelopmental traits alongside measures of pain severity and psychological status, the team aimed to clarify how ADHD and autism spectrum disorder (ASD) relate to chronic pain intensity.
ADHD-related symptoms were more common in this clinical population than expected from general adult prevalence estimates and were closely tied to greater pain intensity. The investigators emphasize that this link appears to be mediated by emotional and cognitive factors—especially anxiety, depression, and catastrophizing—rather than a direct nociceptive effect from ADHD itself.
Dr. Satoshi Kasahara, from the Department of Anesthesiology and Pain Relief Center at the University of Tokyo Hospital, explains that the idea arose from routine clinical observations. “We often see patients with chronic pain who respond poorly to standard physical treatments. Many of these patients display characteristics commonly associated with ADHD—such as inattention, impulsivity, and problems with emotion regulation—which led us to test whether ADHD traits were more prevalent and whether they might influence pain severity,” he said.
The results suggest that properly identifying ADHD traits in patients with persistent pain could alter treatment priorities: shifting the focus from only addressing structural or peripheral causes to also reducing central nervous system arousal and maladaptive thinking that sustain pain. Interventions such as CBT, targeted rehabilitation that includes exercise, and psychoeducation can reduce anxiety, depression, and catastrophic thinking, thereby lowering pain intensity for some patients.
Kasahara and colleagues note that many adults with ADHD do not recognize or report these traits, which can contribute to functional difficulties and strained relationships. For these individuals, psychoeducation that explains ADHD-related patterns and teaches self-management strategies can be as valuable as pharmacological treatment. The authors advocate a comprehensive model that combines medical, psychological, and rehabilitative care to address both brain-behavior characteristics and pain processing.
Funding: This research was supported by the Health and Labor Sciences Research Grants, grant number 19FG2001.
Key Questions Answered:
A: ADHD commonly involves difficulties with emotional regulation. When people with ADHD traits experience pain, they are more likely to engage in negative thought patterns and persistent worry that the pain will not end. This heightened emotional arousal maintains the nervous system in a hypervigilant state, which amplifies perceived pain in the brain.
A: Screening may be helpful if conventional pain treatments aren’t effective and you also struggle with inattention, impulsivity, restlessness, or problems with daily organization and emotion regulation. Identifying ADHD traits can prompt clinicians to include therapies that calm central arousal and address maladaptive coping, such as CBT and structured rehabilitation.
A: This study did not test medications directly. However, the findings suggest that treating ADHD—whether with medication, behavioral strategies, or both—could reduce anxiety and depression that reinforce chronic pain, potentially making pain easier to manage. Clinical trials would be needed to confirm effectiveness.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The journal paper was reviewed in full by editorial staff.
- Additional context was added by the reporting team to clarify implications for clinical practice.
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 is shaped by both physical and psychosocial influences and has been associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, the symptom dimensions most closely tied to pain severity and the mediating psychosocial pathways have not been fully clarified.
This cross-sectional screening study evaluated 958 adult patients who presented to multidisciplinary pain centers in Japan with persistent pain despite standard care. Screening positivity rates were 17.1% for ADHD and 4.4% for ASD. ADHD symptoms—but not ASD symptoms—were substantially associated with higher pain intensity and with reports of extremely severe pain (average numerical rating scale scores of 9–10).
Among patients with extremely severe pain, 27.4% screened positive for ADHD. Hierarchical logistic regression showed that the link between ADHD symptoms and extremely severe pain was reduced after adjusting for anxiety, depression, and pain catastrophizing. Path analyses supported an indirect association in which ADHD symptoms relate to severe chronic pain primarily through emotional distress (anxiety and depression) alone, or through a combined route of emotional distress and catastrophic thinking about pain.
The study concludes that ADHD symptoms are more strongly linked to pain severity than ASD symptoms in patients with refractory chronic pain, and that emotional and cognitive factors are likely key mediators. Routine screening for ADHD symptoms may therefore be important for comprehensive management of severe chronic pain.