ADHD Linked to Fibromyalgia Syndrome

ADHD Linked to Fibromyalgia Syndrome in First-of-Its-Kind Study – Pain Medicine News – by Michael Vlessides

In one of the first-ever studies of its kind, a team of South African researchers found that nearly half of patients with fibromyalgia syndrome (FMS) suffer from concomitant adult attention-deficit/hyperactivity disorder (ADHD).

People suffering from both disorders also reported worse scores on the Revised Fibromyalgia Impact Questionnaire (FIQ-R) and greater cognitive impairment.

Well, this certainly explains a lot. The study also showed that over half of the fibromyalgia patients were depressed and 90% were anxious – no surprise there. 

“As fibromyalgia syndrome is known to have numerous comorbidities, and as the proposed underlying pathophysiology of fibromyalgia syndrome and [ADHD] has overlapping mechanisms, our research aimed to establish if an association existed between these two conditions.”  

To help answer this question, Dr. van Rensburg and his colleagues enrolled 123 patients with previously confirmed FMS into the cross-sectional study, which was conducted between December 2015 and April 2016.

  • The participants were all screened for adult ADHD using the World Health Organization’s Adult ADHD Self-Report Scale v1.1.
  • The FIQ-R was used to assess the effect of FMS.
  • Cognitive assessment was self-reported by the patients, in accordance with the 2011 modified American College of Rheumatology criteria and the FIQ-R, respectively.

44.7% (n=55) of the trial’s participants screened positively for adult ADHD. Results among these 55 patients demonstrated a significant effect on mood disorders and cognition.

Indeed,

  • 31 of the 55 FMS patients with ADHD had a positive screen for depression (56.4%; P=0.019), whereas
  • 50 had a positive screen for anxiety (90.9%; P=0.005).
  • Participants with both FMS and ADHD also scored higher on the FIQ-R than their counterparts with FMS alone (64.74±17.66 vs. 54.10±17.10).
  • Finally, self-reported cognitive impairment was rated higher in the combined group (odds ratio, 10.61; 95% CI, 3.77-29.86; P<0.01)

“The study’s most clinically relevant finding is that there is a considerably high association of adult ADHD in patients with fibromyalgia syndrome,” Dr. van Rensburg told Pain Medicine News. “This has previously been suggested to be around 25%, but our study suggested that it may be as high as 45%.”

I’ve been diagnosed with both fibromyalgia and ADHD, in addition to my EDS. Even after my EDS diagnosis, my rheumatologist insisted that I also have fibromyalgia.

But where is the boundary between fibromyalgia and EDS?

The results of the study do not bode well for patients with FMS who already suffer a heavy morbidity load, with common features including chronic pain, fatigue and depression.

“Cognitive impairment in fibromyalgia syndrome does contribute to the morbidity, but the addition of disproportionate dyscognition and inattention, as seen with associated adult ADHD, can worsen the clinical picture significantly,” Dr. van Rensburg said. “These patients have an increased risk of poor quality of life,

The association between FMS and ADHD could have significant pharmacotherapeutic implications, leading the investigators to recommend that all patients with FMS be assessed for the presence of adult ADHD.

However, as Robert Bennett, MD, commented, fibromyalgia may mean so much more than just one secondary diagnosis.

“It’s not enough to simply make a diagnosis of fibromyalgia,” said Dr. Bennett, a professor emeritus of medicine at Oregon Health & Science University, in Portland.

“I recently wrote an editorial on secondary fibromyalgia and made a list of about a hundred disorders that have been described as being associated with it. And I think that’s a message for pain physicians and researchers who could provide some clues into fibromyalgia and its treatment.”

It seems that fibromyalgia could be a result of any condition that causes relentless pain and fatigue.

Perhaps patients presenting with fibromyalgia have an underlying medical condition that has just not been discovered yet, like EDS, which is often first diagnosed as fibromyalgia.

Nevertheless, Dr. Bennett noted that ADHD may require specific attention before FMS can be successfully treated.

“A lot of treating fibromyalgia is talking to people and trying to get them to understand their condition,” he added.

“And that is, of course, even more difficult if the patient has ADHD. So it would be very important to treat the patients for their ADHD, which would help to optimize their understanding of fibromyalgia and enhance their treatment.

This article is just more proof of how fibromyalgia with its associated chronic pain devastates a person’s life, both mentally and physically.

 

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