People with severe chronic pain that has proven to be resistant to treatment may have a new bad guy to blame for their worsening condition: undiagnosed ADHD.

A large study published in Scientific Reports looked at 958 patients across 13 specialized pain centers in Japan. Every participant had been living with pain for at least three months that hadn’t responded to standard treatment. They found that 17 percent of patients screened positive for ADHD symptoms. That’s more than double the general population rate. 27 percent of the study participants experiencing the most extreme pain had ADHD.

As the pain got more severe, so did the likelihood of ADHD symptoms. They didn’t find the same correlation with autism, which they also measured. ADHD stood out as the lone variable that tracked closely with how bad their pain felt.

ADHD Might Be Pouring Gas on Chronic Pain

It should be noted that this isn’t as simple as irresponsibly and boldly declaring that ADHD causes pain. The researchers suggest a more nuanced explanation. Patients with ADHD symptoms also had higher levels of anxiety, depression, and catastrophic thinking. It was those ADHD offshoots that were specifically linked to worse pain. The brain’s emotional response is amplifying the body’s physical pain signals.

The researchers say that most chronic pain patients aren’t being screened for ADHD at all and are just being treated in orthopedic or pain clinics where neurodevelopmental conditions aren’t considered. All the researchers are arguing is that maybe patients experiencing chronic, untreatable pain should be checked for ADHD. It’s likely not the source of their pain, but, according to their findings, it may be a major contributing factor.

Maybe a painkiller is still necessary to treat the physical agony patients are experiencing, but maybe also treating ADHD symptoms at the same time could make an even bigger dent.