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Hi! David Rosenberg here for the Psychopharmacology Institute. In this Child and Adolescent Psychiatry Smart Take, we examine the impact of methylphenidate on chronic pain and pain thresholds in children with ADHD vs healthy controls. The study compares children with ADHD treated with methylphenidate to those not treated. Intriguingly, both groups with ADHD exhibited lower pain thresholds than healthy controls, aligning with evidence that chronic psychiatric illnesses can be associated with pain. This is significant given ADHD patients’ higher accident proneness and impulsivity.
Investigators found that ADHD patients on methylphenidate had higher pain thresholds compared with those not on stimulant medications, indicating a potential moderating effect of methylphenidate on pain sensitivity. However, even with methylphenidate treatment, these patients still had lower pain thresholds than healthy controls.
This study is notable as the first to explore chronic pain perception and thresholds in children with ADHD using the pressure pain test. It reveals that children with ADHD are more sensitive to pain, a finding consistent with adult research but novel in the pediatric ADHD population. It also differentiates between the responses of ADHD patients on methylphenidate vs those not on the medication.
One limitation of the study is the use of siblings of ADHD patients as controls, which could introduce bias. This factor requires further investigation to validate the findings.
In conclusion, this study highlights the intersection of pain sensitivity and behavioral disorders like ADHD. It suggests that methylphenidate treatment in ADHD patients may increase pain thresholds, although they remain lower than in healthy pediatric controls. This research opens avenues for deeper understanding and better management of pain in ADHD patients.
Abstract
Background: Pain perception is important in children with attention deficit hyperactivity disorder (ADHD) since they are more likely to experience painful events due to increased accident rates. The aim of this study is to contribute to the literature concerning the relationship between ADHD diagnosis, methylphenidate (MPH) therapy, and pain thresholds, since findings regarding the change in pain perception in children with ADHD are scarce and inconsistent.
Methods: Children aged 8-13 years constituted both the ADHD group (n = 82) and the healthy controls (n = 41). The ADHD group was divided into two subgroups, ADHD without MPH (not treated pharmacologically) and ADHD with MPH (treated pharmacologically for at least three-months). The Conners’ Parent Rating Scale-Revised: Short Form was employed to assess ADHD, a visual analog scale was applied to evaluate chronic pain severity, and a manual pressure algometer was used to assess pain thresholds.
Result: Children with ADHD had lower pain thresholds than the healthy controls (P < 0.05). However, lower regional pain thresholds were observed in the ADHD group without MPH compared to both the healthy control and ADHD with MPH groups. Although pain thresholds in the ADHD with MPH group were regionally lower than in the healthy controls, low pain thresholds were found in fewer regions compared to the ADHD without MPH group.
Conclusions: Children with ADHD are more sensitive to pain sensation, and MPH may help normalize these individuals’ pain experiences by raising pain thresholds. Families and clinicians must be aware of situations that may cause pain in children with ADHD. In addition, these children’s low threshold for pain may lead them to experience it more intensely.
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Reference
Bozkurt, A., & Balta, S. (2023). The effect of methylphenidate on pain perception thresholds in children with attention deficit hyperactivity disorder. Child and Adolescent Psychiatry and Mental Health, 17(1), 118.
