PURPOSE: Low back pain (LBP) is a major contributor to reduced quality of life and increasing global healthcare burdens. Recently, adult attention-deficit hyperactivity disorder (ADHD) has been associated with chronic pain interference. In this study, we examined the prevalence and characteristics of ADHD symptoms in the general population and their association with LBP.
METHODS: This nationwide cross-sectional observational study included 2,113 participants from a survey of randomly selected residents aged ≥ 20 years. Self-reported ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS), a screening instrument for possible ADHD in adults. Perceived stress and psychological distress were assessed with the Perceived Stress Scale (PSS) and the Kessler 6-Item Psychological Distress Scale (K6), respectively. Participants were grouped by LBP status as no LBP, acute/subacute LBP, or chronic LBP, and multinomial logistic regression was used to identify the factors associated with each; models with and without the PSS and K6 were compared.
RESULTS: A positive ADHD screen was identified in 3.27% of participants, of whom 23.2% reported chronic LBP compared with 11.0% of screen-negative participants. A higher ASRS score was associated with chronic LBP after adjustment (adjusted odds ratio [aOR] 1.255 per 10-point increase, 95% confidence interval 1.051-1.509, p = 0.010), as were older age, comorbidity burden, smoking, and the PSS and K6 scores. None of the psychosocial measures was associated with acute/subacute LBP. The aOR for the ASRS score fell from 1.548 to 1.255 when the PSS and K6 were added to the model but remained significant.
DISCUSSION: A positive ADHD screen on the ASRS was identified in 3.27% of participants from the general population, and a higher score for self-reported adult ADHD symptoms remained statistically associated with chronic LBP after adjustment for established associated factors, including perceived stress and psychological distress.
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