This is how I deal with chronic pain, I am in chronic pain from the very moment I open my eyes, it takes awhile to get all my deregulaions activated, breathing is most important once i get control of my breathing under control the better my days is, some days it can take two hours for me to remember how to breath. If i dont get control it is a long day of constant asma attacks. Everybreath is a struggle

But when it comes to pain which i am always in i just choose what pain to focus on i usually choose a pain i can fix with exercise like a sore back which is better than focusing on a migraine which is the worst, it like a meat cleaver in my head.

How one pain can distract from another pain

At first glance, it may sound odd: you have a back pain that’s been chronic, then you injure your leg (or fall on one side), and you say that you forgot about the back pain, or that it faded into the background. What’s going on? The key lies in how the brain processes pain, attention, and how multiple pain signals compete (and sometimes one dominates) in our nervous system. The effect is not unlike a Quality of Service (QoS) telecommunications network with advanced signal processing.

Pain is not just a “signal” from body to brain

It helps to remember that pain is far more than “an alarm” from a damaged tissue. Modern neuroscience describes pain with a multi-stage model:

Transduction: damaged tissue / noxious stimulus → nerve endings (nociceptors) generate signals.

Transmission: signals travel via peripheral nerves, up the spinal cord (via e.g. the spinothalamic tract) to thalamus and brain.

Modulation: at the spinal cord and brain levels, signals are amplified or suppressed (descending pathways, interneurons, attentional/affective influence).

Perception: the final “pain experience” involves somatosensory cortex (where it is, how intense), but also the insula, anterior cingulate cortex (ACC) and other regions tied to emotion, attention, meaning.

Thus, your brain is not a passive receiver of pain; it actively constructs the experience of pain, based on body signals plus attention, expectations, emotions, competing stimuli, context, prior pain, etc.

Attention, distraction and pain

One major reason why one pain may “drown out” or distract from another is the way attention and pain interplay. In essence: the brain has limited attentional “bandwidth,” and pain captures attention. If a new, more salient pain arrives (e.g., from a fall or an acute injury), it may monopolize attention, leaving less “neural space” for the chronic pain.

Impact of ADHD on Pain and Chronic Pain Management

Pain management for ADHD involves addressing the connection between attention, emotion, and pain perception, often using ADHD medications (like methylphenidate), which can directly lower pain sensitivity, alongside therapies like CBT, mindfulness, and activity to manage emotional responses and improve coping. Since ADHD increases pain sensitivity (lower pain thresholds), treating the ADHD itself can significantly reduce pain, but a holistic approach with therapists, OTs, and physical therapy helps manage the complex interplay of symptoms and pain. 

Pharmacological Approaches

ADHD Medications: Stimulants (like methylphenidate) and non-stimulants can improve pain by targeting neurotransmitters (dopamine, norepinephrine) involved in both ADHD and pain processing, reducing central sensitization.

Other Medications: Antidepressants or other drugs used for ADHD may also help with comorbid pain. 

Behavioral & Therapeutic Strategies

Cognitive Behavioral Therapy (CBT) & Mindfulness: Teaches emotional regulation and alters negative thought patterns, reducing pain intensity.

Occupational Therapy (OT): Helps with pain journaling to understand triggers, sleep hygiene, and activity pacing.

Physical Therapy & Exercise: Improves function, reduces pain, and helps with motor regulation issues common in ADHD.

Distraction & Focus: Using selective attention to focus on a non-pain task can temporarily relieve pain. 

Lifestyle & Holistic Care

Sleep: Prioritizing restful sleep reduces inflammation that exacerbates pain and ADHD.

Movement: Regular, moderate exercise (like 150 mins/week) helps manage pain.

Holistic Treatments: Acupuncture, massage, or cannabis (where legal) can provide relief, notes Shimmer ADHD Coaching. 

Key Considerations

Undiagnosed ADHD: Many chronic pain patients have undiagnosed ADHD, which often goes overlooked by pain specialists.

Impulsivity: ADHD’s impulsivity can lead to high-risk treatments or abandoning therapies too soon. 

In essence, treating ADHD directly often lessens pain, but combining it with therapies that build coping skills is crucial for managing the interwoven physical and emotional aspects of pain in ADHD

Introduction

There is recent evidence suggesting a relationship between Attention-Deficit/Hyperactive Disorder. These two conditions have been determined to have shared multifactorial origins.[1][2]A scoping review revealed results from research demonstrating a higher incidence of ADHD among kids with chronic pain, as well as a higher prevalence of chronic pain in ADHD-related samples.[3] “At present, there are no established health care routines for examining psychiatric symptoms when investigating functional pain conditions in a somatic care setting, nor is there any knowledge of offering patients with ADHD or other neuro-psychiatric diagnoses adapted treatments for pain conditions.[1]” There have been proposed and well-documented studies showing the coexistence of abnormal pain perception and ADHD. Some of the studies are more theoretical or have low power: several with in-depth looks at neurophysiological comparisons and changes have been in vivo-based studies. The following areas have more robust evidence:

Abnormal sensory processing in ADHD and pain transmission[4]

Psychiatric disorders such as anxiety and depression occur with chronic pain and ADHD[5]

Areas of the brain that show pathological changes in ADHD are also responsible for processing pain pathways[6][7](see additional resources on the Chronic Pain and the Brain page)

Neuroinflammation is present in multiple psychiatric disorders, and evidence in a 2017 systematic review suggests an association with ADHD[8]  and is well established in its association with acute pain tissue healing and as a trigger for chronic pain central sensitisation[9][10](See Neurogenic Inflammation in Musculoskeletal Conditions for additional information on neuroinflammation and pain

This video further expanded the patients’ view of what it is like to have chronic pain and ADHD

[11]

Responsibilities of the different providers on the multidisciplinary team

Because of the many facets of ADHD, consider narrowing your focus and presentation to help accommodate cognitive, emotional and psychiatric co-morbidities that may be present in patients with ADHD when utilising Pain Neuroscience Education and Cognitive Functional Therapy approaches.

Physical therapist

To encompass the shared presentation of ADHD and Pain or ADHD and Chronic Pain, physical therapists may use a variety of therapeutic approaches:

A mechanical assessment to evaluate movement baselines and needs for improved mobility for pain modulation or abolishment to alleviate shared psychiatric symptoms between ADHD and acute pain or chronic pain such as unrealistic fear about movement, anxiety of re-injury or not being able to return to work, utilising treatment time to teach functional movements

Manual therapy is a commonly used therapeutic approach to manage ADHD symptoms with pain and or chronic pain symptoms to promote relaxation, pain alleviating functional mobility

Pain Neuroscience Education serves as single or group therapy method to teach good and bad pain, and just because something is hurting when you are doing it, such as an exercise or functional movement, it doesn’t mean it is harmful. A patient dealing with ADHD needs the assurance that the activity and exercise they are doing to help anxiety and depression may cause some discomfort; this is normal, as just one example of the benefits of PNE for ADHD. Helping patients process through the pain and ADHD via PNE may show benefits concurrently with these diagnoses. This education could also be tailered speciacally for children ( see Pain Neuroscience Education for Chidren).

Occupational Therapist

Utilise a pain journal with a patient suffering these symptoms to help the ADHD patient process through the emotions and the fears, and the anxiety they experience along with what is triggering episodes of persistent pain. [12]

Educate the patient on how poor sleep can increase inflammatory levels that are present in ADHD and persistent pain. Providing education on sleep health and maximising their ability to experience the most restful sleep possible for patients struggling with ADHD, with pain or chronic pain

Neuropsychiatrist

Responsible for diagnosis of ADHD and needs for pharmacological therapeutics that would most likely alleviate ADHD symptoms, but possibly assist in persistent pain symptoms

Referrals as indicated to psychological counselling for talk therapy management for ADHD, while considering the impact of ADHD on the patient’s persistent pain

Additional considerations

Be cognizant of the fact that only 20% of patients with ADHD are diagnosed by a psychiatrist.[13] Always consider an appropriate referral process to a neuropsychiatrist

Pharmacological medication for ADHD showing promising findings in chronic pain alleviation

In a case study by Zain et. al.[15], methylphenidate improved the chronic pain symptoms in a 43 y/o male with newly diagnosed ADHD. He had a 15-year history of idiopathic pain and was prescribed an osmotic release oral system of methylphenidate. The result was an abolishment of pain in 4 weeks, return of normal function with daily activities, and no reoccurrence of pain for 7 years. In addition, his ADHD symptoms improved with no stimulant addiction issues.