Case Report: Methylphenidate and venlafaxine improved abdominal nociplastic pain in an adult patient with attention deficit hyperactivity disorder, autism spectrum disorder, and comorbid major depression.

IF 2.5 Q2 CLINICAL NEUROLOGY
Frontiers in pain research (Lausanne, Switzerland) Pub Date : 2024-08-21 eCollection Date: 2024-01-01 DOI:10.3389/fpain.2024.1394131
Satoshi Kasahara, Miwako Takahashi, Kaori Takahashi, Taito Morita, Ko Matsudaira, Naoko Sato, Toshimitsu Momose, Shin-Ichi Niwa, Kanji Uchida
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Abstract

Introduction: Nociplastic pain (NP), classified as a third type of pain alongside nociceptive and neuropathic pain, is chronic pain arising from the amplification of nociceptive stimuli through central sensitization, despite the absence of tissue damage, sensory nerve damage, or disease. An important clinical feature of NP is that it is not only associated with pain but also with sensory hypersensitivity to sound and light and cognitive dysfunction, including mood and attention disorders. Recent studies have suggested that depression and developmental disorders, such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), coexist with NP at high frequency. Additionally, cognitive impairment in individuals with NP may be associated with these psychiatric comorbidities. However, to our knowledge, there are no reports on (1) multidimensional evaluation and diagnostic details of abdominal NP in adults with ADHD/ASD; (2) how ADHD drugs and antidepressants are administered when ADHD and depression coexist with NP; and (3) how central sensitization, brain function, and family relationship problems underlying NP are altered by treatments of ADHD and depression.

Case presentation: Herein, we present the case of a 51-year-old woman with abdominal NP. She developed severe right lower abdominal pain and underwent a thorough medical examination; however, the physical, medical cause remained unknown, making treatment challenging. Additionally, she took time off work as she began to complain of insomnia and anxiety. She was referred to our pain center, where a diagnosis of depression, ADHD, and ASD was confirmed, and treatment with ADHD medication was initiated. While ADHD medications alone did not yield sufficient improvement, a combination of methylphenidate and the antidepressant venlafaxine eventually led to improvements in abdominal NP, depression, ADHD symptoms, central sensitization, and family relationship issues. During treatment, cerebral blood flow in the anterior cingulate, prefrontal, and parietal cortices also improved.

Conclusion: The treatment of comorbid depression is important while treating NP, and venlafaxine may be effective, especially in cases of comorbid ADHD/ASD. Screening for developmental disorders and depression is required in patients with abdominal NP.

病例报告:哌醋甲酯和文拉法辛改善了一名患有注意力缺陷多动障碍、自闭症谱系障碍和合并重度抑郁症的成年患者的腹部神经性疼痛。
简介非痉挛性疼痛(NP)被归类为与痛觉性疼痛和神经病理性疼痛并列的第三种疼痛类型,是指尽管没有组织损伤、感觉神经损伤或疾病,但痛觉刺激通过中枢敏化被放大而产生的慢性疼痛。神经病理性疼痛的一个重要临床特征是,它不仅伴有疼痛,还伴有对声音和光线的感觉过敏以及认知功能障碍,包括情绪和注意力障碍。最近的研究表明,抑郁症和发育障碍(如注意力缺陷多动障碍(ADHD)和自闭症谱系障碍(ASD))与 NP 高频共存。此外,NP 患者的认知障碍可能与这些精神疾病合并症有关。然而,据我们所知,目前还没有关于以下方面的报道:(1)多动症/ASD 成人腹型 NP 的多维评估和诊断细节;(2)当多动症和抑郁症与 NP 并存时,如何使用多动症药物和抗抑郁药物;以及(3)多动症和抑郁症的治疗如何改变 NP 的中枢敏感性、大脑功能和家庭关系问题:在此,我们介绍了一名 51 岁女性腹型 NP 患者的病例。她出现了严重的右下腹疼痛,并接受了全面的医学检查;然而,物理和医学原因仍然不明,这给治疗带来了挑战。此外,她开始抱怨失眠和焦虑,因此请了假。她被转诊到我们的疼痛中心,确诊为抑郁症、ADHD 和 ASD,并开始接受 ADHD 药物治疗。虽然单用多动症药物治疗效果并不理想,但联合使用哌醋甲酯和抗抑郁药物文拉法辛最终改善了腹部 NP、抑郁、多动症症状、中枢敏感性和家庭关系问题。治疗期间,前扣带回、前额叶和顶叶皮质的脑血流量也有所改善:文拉法辛可能有效,尤其是对合并多动症/注意力缺陷障碍的病例。需要对腹型 NP 患者进行发育障碍和抑郁症筛查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
2.10
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