A study published in Scientific Reports suggests that screening for ADHD symptoms may be crucial in managing severe chronic pain.
Key Finding: Researchers at the University of Tokyo Hospital found that ADHD symptoms and severe chronic pain may be linked through anxiety, depression, and pain catastrophizing.
Study Overview
The study, published on April 23, 2026, involved 958 individuals aged 20 years and older with persistent chronic pain from 13 multidisciplinary pain clinics in Japan.
- Median age: 58 years
- Male participants: 40.6%
- Extremely severe pain (NRS 9–10): 8.4%
ADHD and ASD Screening Results
17% of participants screened positive for ADHD using the Adult ADHD Self-Report Scale (ASRS; at least 4 positive responses to 6 items).
- 4.4% screened positive for ASD using the Autism-Spectrum Quotient (score ≥33).
- Among those with extremely severe pain, 27.4% screened positive for ADHD vs. 16.1% without extremely severe pain.
- No significant association was found between ASD and extremely severe pain (8.3% vs. 4.0%).
"We found that ADHD-related traits were more common in these patients than in the general population, about 2.4 times higher." — Lead author Dr. Satoshi Kasahara
Health Impacts
ADHD-positive participants reported significantly worse outcomes across multiple measures:
- Higher pain severity
- Worse functional impairment
- Higher rates of insomnia
- Increased depression and anxiety
- Lower health-related quality of life
- Reduced pain self-efficacy
- Notably, only ADHD-positive and negative groups differed on pain catastrophizing.
Path Analysis and Mechanism
Path analyses indicated that the association between ADHD symptoms and severe chronic pain was mediated by anxiety and depression, alone or combined with pain catastrophizing.
The authors note that adult ADHD is commonly comorbid with depression, anxiety, and insomnia, suggesting ADHD symptoms may contribute to pain through these conditions. However, clinical diagnoses of ADHD were not established.
Important Limitations
- ADHD and ASD symptoms were self-reported.
- The ASRS has a reported false-negative rate of 31.3%.
- When accounting for this, an estimated 24.9% of all participants and 39.9% of those with average pain 9–10 could meet diagnostic criteria.
Clinical Implications
The researchers conclude that detecting and treating ADHD in chronic pain patients may lead to broader health benefits, and that screening and management of ADHD symptoms should be prioritized in clinical care for those with persistent chronic pain.