Fibromyalgia’s most common (and well known) symptoms include muscle pain and fatigue. The condition, however, also includes a range of symptoms affecting memory, attention, and concentration, known collectively as dyscognition.
Dyscognition may be “more disabling than chronic pain,” the study’s authors write, but is mostly under-recognized or under-treated. They concluded that the higher FIQ-R scores “could possibly be attributed to both the impact of dyscognition and the higher frequencies of anxiety and/or depression in patients with unrecognized adult ADHD.”
Patients with FMS have altered neurotransmitter activity involved in pain sensitivity, such as dopamine, serotonin, and nor adrenaline. Likewise, ADHD is a chronic neurodevelopment disorder also associated with impaired cognition and altered neurotransmitters.
Attention-deficit hyperactivity disorder (ADHD)
Attention-deficit hyperactivity disorder (ADHD) seems to be more frequent in women with fibromyalgia than in those without this disorder, and those patients tend to have more occurrences of impulsive behavior. A study with those findings, “Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia,” was published in the journal Neuropsychiatric Disease and Treatment.
Fibro fog is common in fibromyalgia patients, involving symptoms such as mental confusion, difficulty concentrating and staying attentive, memory loss, and speech impairment. These cognitive deficits are similar to those of ADHD, which is characterized by ongoing lack of attention and/or hyperactivity-impulsivity. Notably, ADHD patients show a marked incidence of fibromyalgia.
What the Fibro-ADHD Study Found
In this study, more than 100 people with fibromyalgia were screened for adult ADHD by taking a screening questionnaire developed by the World Health Organization (WHO). Items on this 18-question screening tool include these queries:
- >>How often do you make careless mistakes when you have to work on a boring or difficult project?
- >>How often do you misplace or have difficulty finding things at home or at work?
- >>When you have a task that requires a lot of thought, how often do you avoid or delay getting started?
- >>Participants also had their cognition evaluated.
Study findings
What the researchers found is that a whopping 45 percent of the people with fibromyalgia screened positive for adult ADHD. Most of the people who had ADHD knew on some level that they had a problem they had reported cognitive impairment in higher numbers than those without the accompanying condition. Results of this study were also published in the journal Pain Medicine in November 2017.
Evidence suggests the involvement of the central nervous system
Increasing evidence suggests the involvement of the central nervous system, particularly the neurotransmitters nor adrenaline and dopamine, in both conditions. Moreover, case studies show that treatment with the ADHD medication atomoxetine, which does not raise the levels of nor adrenaline outside cells is an effective strategy to ease pain associated with fibromyalgia. As for impulsive behavior, research has suggested that it is highly prevalent in patients with fibromyalgia, but available data is still scarce.
Research
The researchers assessed 78 women with fibromyalgia (mean age 40.3 years) and 54 healthy people in the control group. Symptoms of fibromyalgia, including widespread pain, were present at a similar level for at least three months.
The results showed that ADHD was found in 23 fibromyalgia patients (29.5%) and in four healthy controls (7.4%). Also, 66% of subjects who had been diagnosed with ADHD in childhood still had the disorder in adulthood. Importantly, 33.3% of patients with fibromyalgia, but only 11.1% of controls, already had ADHD in childhood and adolescence, as gleaned from information provided by the subjects.
Also, the findings showed that patients with fibromyalgia had higher scores than controls in scales of attention deficit, hyperactivity and impulsivity, including a self-report assessment in adults. In particular, while no differences were found in impulsivity described as acting without thinking patients with fibromyalgia scored higher in sub-scales specific to lack of planning
Both adult and childhood ADHD are quite common in female fibromyalgia patients
“The present study has shown that both adult and childhood ADHD are quite common in female fibromyalgia patients,” the researchers wrote. “High frequency of both childhood and adult ADHD among fibromyalgia patients suggests that ADHD could be a predictor of the development of fibromyalgia in the future,” they added.
While they noted that the link suggests at least one subgroup of fibromyalgia may share the same causes as ADHD, the scientists said it would be important in future studies to evaluate whether the fibromyalgia-impulsivity is associated with ADHD, or is independent.
Ask your doctor for a screening test
The researchers recommend that if you have fibromyalgia, you should be screened for adult ADHD. “The significant impact of probable adult ADHD indicates that all patients with FMS should be screened for comorbid adult ADHD,” the study concludes. Your primary care provider can administer the WHO screening questionnaire. If you test positive, you would then be assessed by a neurologist or psychiatrist before receiving a formal diagnosis.
Treatments can help
According to the nonprofit organization Children and Adults with Attention-Deficit/Hyperactivity Disorder, there are strategies people with ADHD can use to compensate for some of their cognitive problems. Some of these include systematically organizing your work space to cut down on distractions or dividing each task into smaller steps and rewarding yourself when you complete each one. Adults with ADHD often benefit from having cognitive behavioral therapy or hiring a personal coach to help set manageable goals.
Medications
Medications such as stimulants or antidepressants can help with ADHD. Van Rensburg notes that some case studies suggest that the psychostimulant Ritalin (methylphenidate) not only improves the cognitive symptoms, it also seems to benefit fibromyalgia pain. Clinical trials are required to confirm this, but you might want to talk to your doctor about this medication.
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References:
A study with those findings, “Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia,” was published in the journal Neuropsychiatric Disease and Treatment.
ADHD More Common in Women with Fibromyalgia, Study Shows BY JOSE MARQUES LOPES, PHD via Fibromyalgia News Today
