ADHD Traits May Be Driving Chronic Pain

When chronic pain refuses to heal, the obstacle might be a neurodevelopmental trait that has gone unnoticed for years.

A study from the University of Tokyo found a link between attention-deficit/hyperactivity disorder (ADHD) symptoms and treatment-resistant pain.

The data indicated that ADHD traits do not cause pain directly; instead, they amplify it through an anxiety/depression pathway.

The intersection of ADHD and chronic pain

ADHD is often associated with difficulty staying on task, impulsivity, or restless energy. However, neurodevelopmental traits rarely exist in isolation.

These behaviors often intersect with how the brain processes physical sensations, leading researchers to explore an overlap: the link between ADHD and chronic pain.

While most people think of pain as a purely physical reaction to injury, it is better described as a complex, biological, and psychological experience. When pain persists for months or years and resists conventional treatments, the root cause is often found in how the nervous system and mind interact.

Scientists have suspected that neurodevelopmental conditions, such as ADHD and autism (ASD), might change a person’s pain perception, but there was a lack of data from large-scale clinical settings to show how these traits influence pain levels.

“This research began from everyday clinical experience. In our practice, we frequently encounter patients with chronic pain who do not respond well to conventional treatments. Among these patients, many show characteristics commonly seen in ADHD, such as inattention, hyperactivity, or impulsivity, and difficulties with emotional regulation,” said lead author Dr. Satoshi Kasahara, an associate professor from the University of Tokyo.

“This led us to consider whether ADHD-related traits might be more common in this population than previously recognized, and whether they could be contributing to the persistence and severity of pain,” he added.

High prevalence of ADHD traits in pain centers

Kasahara and the team conducted a cross-sectional screening of 958 adult patients.

“We looked at patients with severe chronic pain who were being treated at specialized pain centers across Japan and examined how often ADHD- and autism-related traits were present in this population,” explained Kasahara.

The researchers used the Adult ADHD Self-Report Scale and the Autism-Spectrum Quotient to screen for traits, while patients rated their pain intensity using a standard numerical scale.

Around 17.1% of patients screened positive for ADHD—a rate ~2.4 times higher than seen in the general population.

While autism screening positivity also measured at 4.4%, autism traits did not share the same strong link to pain intensity.

“We found that ADHD-related traits were more common in these patients than in the general population. These traits were also closely linked to pain severity, as well as to psychological factors such as anxiety, depression, and negative ways of thinking about pain,” said Kasahara.

The correlation was most visible at the end of the scale: 27.4% of those reporting the highest possible pain levels screened positive for ADHD.

Statistical analysis showed that ADHD symptoms drove this severity indirectly, appearing to fuel a cycle of anxiety and depression, which led to pain catastrophizing—a tendency to assume the worst about physical sensations.

Map Neurological Disease Beyond Known Biomarkers

This infographic explores a scalable systems-level proteomics approach that reveals novel biomarker candidates and deepens understanding of neurological disease mechanisms.
View Infographic

Advertisement

Improving chronic pain outcomes with ADHD screening

Many adults with ADHD remain undiagnosed, which could mean thousands of patients are entering pain clinics without anyone realizing their neurodevelopmental traits are making their physical symptoms harder to treat.

If routine ADHD screening became a standard part of multidisciplinary pain care, healthcare professionals could identify these traits early, allowing clinicians to offer more personalized support.

However, due to the nature of the study, the findings only suggest a connection, and they do not show that ADHD causes chronic pain.

Future interventional research is needed to see if treating ADHD symptoms directly can lower pain scores.

“For example, approaches such as cognitive behavioral therapy and rehabilitation programs that include exercise have been widely used, and are considered effective in improving anxiety, depression, and negative ways of thinking about pain, which in turn can help reduce chronic pain,” said Kasahara.

He pointed out that many patients may not even recognize these traits in themselves, which adds to their daily struggle. “In such cases, psychoeducation, helping patients understand their own characteristics, and learn how to better manage their behavior, can also play an important role. These kinds of approaches may be just as important as medication, and a comprehensive approach that combines medical, psychological, and rehabilitative care is likely to be the most effective,” said Kasahara.

Reference: Kasahara S, Aono S, Takatsuki K, Niwa SI, Yabuki S. Attention-deficit/hyperactivity disorder and autism spectrum disorder in chronic pain: a study in Japanese pain centers. Sci Rep. 2026;16(1):10544. doi: 10.1038/s41598-026-45300-y

This article is a rework of a press release issued by the University of Tokyo. Material has been edited for length and content.