By Meryl Davids Landau
a new studay says,
Problems thinking and remembering may be more than fibro fog; they may be ADHD.
If you have fibromyalgia, you might want to be examined by your doctor for attention deficit hyperactivity disorder (ADHD) as well.
That’s the message from a study presented at the annual meeting of the American Academy of Pain Management in April 2018. It found a startling high rate of co-occurrence of these conditions.
Fibromyalgia: Chronic Pain and More
Fibromyalgia syndrome (FMS) is a chronic pain disorder. In addition to musculoskeletal pain, it is associated with numerous other symptoms, including chronic fatigue, problems sleeping, dizziness, sensitivity to light, and others.
Many people also experience problems thinking or remembering, a symptom that is known as “fibro fog.”
Other Diseases Can Come Along for the Ride
Fibromyalgia is not well understood, but one thing researchers know is that it is often accompanied by other medical conditions. Those that are known include depression, anxiety, interstitial cystitis (a bladder condition), and irritable bowel syndrome.
That’s where this study comes in. Researchers from the University of Pretoria in South Africa began noticing that some adults with fibromyalgia suffered from extreme forms of impaired cognition and inattention. They wondered if this, too, could indicate a co-occurring condition rather than a symptom of the disease.
Roland van Rensburg, a physician with the university, wondered whether those people with fibromyalgia who had more extreme fibro fog symptoms might actually have undiagnosed ADHD.
“In both conditions, patients have problems with thinking, remembering, focusing, or sustaining attention, which is generically termed dyscognition or cognitive impairment,” he says.
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.
Almost Half of Participants Had Both Conditions
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.
Dopamine Is the Likely Link
The connection between the two diseases can likely be found in the underlying dysfunction in the brain that seems to cause each condition.
“FMS appears to be caused by dysregulation of neurotransmitters, mainly dopamine and serotonin, and abnormalities of these neurotransmitters are also implicated in the development of ADHD,” Dr. van Rensburg explains. “The connection between the two seems to lie in the underlying problems with the neurotransmitters.”
A Very Bothersome Symptom
The concentration and attention issues that people with both of these conditions experience can be a big deal for patients, the researchers say. These issues are sometimes more disabling than the chronic pain, they note in the study.
Yet many doctors and researchers tend to overlook these symptoms, they say.
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.
Strategies and 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 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.