ADHD and Fibromyalgia - How are they associated?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain. It’s often accompanied by fatigue, sleep disturbances, memory issues and mood changes. While its exact cause is unknown, fibromyalgia is thought to amplify pain sensations by affecting how the brain and spinal cord process pain signals. In this blog, we’ll explore the different aspects of the potential connection between ADHD and fibromyalgia.
Fibromyalgia symptoms can vary in intensity and may include tender points on the body, headaches, and digestive problems.
And women are more commonly affected than men.
While there's no cure, treatments focus on managing symptoms through medication, lifestyle changes and therapies to improve quality of life.
ADHD and fibromyalgia
In recent years emerging research has suggested an overlap between ADHD and fibromyalgia.
Both disorders, though distinct in their primary symptoms, share several cognitive and neurological similarities. That may explain the higher prevalence of ADHD among fibromyalgia patients.
We will here delve into how common the connection is and what the shared symptoms can look like. And how possible neurobiological mechanisms may overlap.
How common is it?
The comorbidity between ADHD and fibromyalgia is well described in the medical literature. Many studies have already looked at the overlap between ADHD and fibromyalgia;
estimating that about 25% of fibromyalgia patients also have ADHD (1).
No studies, however, have to our knowledge sought to assess how common fibromyalgia is among adults with ADHD.
Shared Cognitive Symptoms?
Both fibromyalgia and ADHD are associated with cognitive difficulties. Such as problems with memory, concentration and attention.
Fibromyalgia patients describe these symptoms as "fibro fog". Mirroring many of the cognitive impairments seen in ADHD.
The overlapping symptoms could suggest that the two conditions may share underlying mechanisms.
We have yet to explore if there may be similarities in dysregulation in neurotransmitter systems like dopamine, serotonin and norepinephrine.
What about treatment?
The similarities between ADHD and fibromyalgia raise questions about the potential for cross-treatment strategies and shared therapeutic interventions.
Indeed, an earlier study indicated that treatment with stimulants could relieve symptoms of both ADHD and fibromyalgia (2). There’s no randomized controlled trial evidence to support this clinical observation.
However, it seems likely that improving everyday functioning and quality of life through evidence-based treatment for ADHD could also also affect fibromyalgia indirectly and positively.
Also interesting to note, is that another study has shown that central stimulant ADHD medication can improve the tolerability of pain in adults without fibromyalgia (3).
A double whammy?
The presence of ADHD in fibromyalgia patients will worsen the overall burden of the disease and affect the overall quality of life.
Individuals suffering from both conditions often experience more severe fibromyalgia symptoms, poorer functional outcomes and higher scores on fibromyalgia impact questionnaires.
Moreover, childhood ADHD symptoms have been identified as a factor in worsened functioning for fibromyalgia patients in adulthood. And underscoring the importance of early diagnosis and intervention. (4)
Challenges in Diagnosis and Treatment
Despite growing evidence of the ADHD-fibromyalgia connection, both conditions are often underdiagnosed and mismanaged in females.
Clinicians may overlook the cognitive symptoms in fibromyalgia, mistakenly attributing them solely to "fibro fog". And vice versa, misinterpret sensory symptoms in ADHD for psychosomatic complaints.
Many researchers and clinicians specialized, argue for a systematic screening of fibromyalgia patients for ADHD symptoms. And the other way around, to ensure that both conditions are appropriately treated.
Cognitive impairments in fibromyalgia, especially those related to ADHD, may not respond well to traditional treatments for fibromyalgia alone, necessitating a more comprehensive approach.
Many disorders and symptoms unique to or overrepresented in women are less researched, and more often miss- or undiagnosed.
Why this is, we can only speculate about.
However, recognizing the overlap between conditions such as ADHD and fibromyalgia is critical for improving patient outcomes.
Lotta Borg Skoglund
MD PhD & Letterlife co-founder
References:
Derksen, M. T., Vreeling, M. J., & Tchetverikov, I. (2015). High frequency of adult attention deficit hyperactivity disorder among fibromyalgia patients in the Netherlands: should a systematic collaboration between rheumatologists and psychiatrists be sought?. Clinical and experimental rheumatology, 33(1 Suppl 88), S141.
Krause K., Krause J., Magyarosy I., Ernst E., Pongratz D. Fibromyalgia Syndrome and Attention Deficit Hyperactivity Disorder: Is There a Comorbidity and Are There Consequences for the Therapy of Fibromyalgia Syndrome? Journal of Musculoskeletal Pain, volume 6, issue 4, pages 111-116 1998 DOI: 10.1300/J094v06n04_10
Treister, R., Eisenberg, E., Demeter, N., & Pud, D. (2015). Alterations in pain response are partially reversed by methylphenidate (Ritalin) in adults with attention deficit hyperactivity disorder (ADHD). Pain practice: the official journal of World Institute of Pain, 15(1), 4–11. https://doi.org/10.1111/papr.12129
Karaş, H., Çetingök, H., İlişer, R., Çarpar, E., & Kaşer, M. (2020). Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact. International journal of psychiatry in clinical practice, 24(3), 257–263. https://doi.org/10.1080/13651501.2020.1764585