Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related...
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1283823/full |
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| author | Satoshi Kasahara Satoshi Kasahara Shoichiro Kanda Shoichiro Kanda Miwako Takahashi Mao Fujioka Taito Morita Ko Matsudaira Naoko Sato Motoshi Hattori Toshimitsu Momose Shin-Ichi Niwa Kanji Uchida |
| author_facet | Satoshi Kasahara Satoshi Kasahara Shoichiro Kanda Shoichiro Kanda Miwako Takahashi Mao Fujioka Taito Morita Ko Matsudaira Naoko Sato Motoshi Hattori Toshimitsu Momose Shin-Ichi Niwa Kanji Uchida |
| author_sort | Satoshi Kasahara |
| collection | DOAJ |
| description | Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD. |
| first_indexed | 2024-03-11T14:13:19Z |
| format | Article |
| id | doaj.art-882d226a845349e28962af5b374b7b7a |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-11T14:13:19Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-882d226a845349e28962af5b374b7b7a2023-11-01T16:37:36ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-11-011110.3389/fped.2023.12838231283823Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorderSatoshi Kasahara0Satoshi Kasahara1Shoichiro Kanda2Shoichiro Kanda3Miwako Takahashi4Mao Fujioka5Taito Morita6Ko Matsudaira7Naoko Sato8Motoshi Hattori9Toshimitsu Momose10Shin-Ichi Niwa11Kanji Uchida12Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, JapanDepartment of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, JapanDepartment of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, JapanDepartment of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, JapanInstitute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, JapanDepartment of Neuropsychiatry, The University of Tokyo Hospital, Tokyo, JapanDepartment of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, JapanDepartment of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, JapanNursing Department, The University of Tokyo Hospital, Tokyo, JapanDepartment of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, JapanInstitute of Engineering Innovation, School of Engineering, The University of Tokyo, Tokyo, JapanDepartment of Psychiatry, Aizu Medical Center, Fukushima Medical University, Fukushima, JapanDepartment of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, JapanAutosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD.https://www.frontiersin.org/articles/10.3389/fped.2023.1283823/fullautosomal dominant polycystic kidney diseaselower back paincystic fibrosis transmembrane conductance regulatorattention deficit hyperactivity disorderautism spectrum disorderguanfacine |
| spellingShingle | Satoshi Kasahara Satoshi Kasahara Shoichiro Kanda Shoichiro Kanda Miwako Takahashi Mao Fujioka Taito Morita Ko Matsudaira Naoko Sato Motoshi Hattori Toshimitsu Momose Shin-Ichi Niwa Kanji Uchida Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder Frontiers in Pediatrics autosomal dominant polycystic kidney disease lower back pain cystic fibrosis transmembrane conductance regulator attention deficit hyperactivity disorder autism spectrum disorder guanfacine |
| title | Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| title_full | Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| title_fullStr | Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| title_full_unstemmed | Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| title_short | Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| title_sort | case report guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder |
| topic | autosomal dominant polycystic kidney disease lower back pain cystic fibrosis transmembrane conductance regulator attention deficit hyperactivity disorder autism spectrum disorder guanfacine |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1283823/full |
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