ADHD & Fibromyalgia: Understanding the Overlapping Challenges

Table of contents

ADHD & Fibromyalgia: Understanding the Overlapping Challenges

Is there a connection between attention deficit hyperactivity disorder (ADHD) and fibromyalgia?

This article aims to clarify the relationship between these two conditions, delve into the environmental and genetic factors involved, and explain why fibromyalgia encompasses more than just "brain fog." Additionally, we'll offer strategies for managing the symptoms of both ADHD and fibromyalgia.

What is fibromyalgia?

Fibromyalgia, a complex chronic pain disorder, is closely linked to a phenomenon referred to as central sensitization. Those with the condition experience widespread musculoskeletal pain, profound fatigue, and sleep and mood disturbances.

Central sensitization occurs when the nervous system goes into overdrive, maintaining a state of heightened reactivity that accentuates pain. The brain and spinal cord turn up the volume on stimuli and sensations, so that even normal touch or pressure can be perceived as painful.

Fibromyalgia co-morbidity

Fibromyalgia can exist alongside various other health conditions, and studies show people who live with fibromyalgia are significantly more likely to experience other physical and psychological conditions compared to the general population.

Common conditions include:

  • Musculoskeletal conditions: These include chronic pain conditions such as headaches, migraines, and temporomandibular joint (TMJ) dysfunction
  • Neuropsychiatric conditions: Depression, anxiety, ADHD and sleep disturbances1.
  • Other chronic conditions: Irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), and certain autoimmune diseases such as rheumatoid arthritis and lupus2.

How closely linked are ADHD & fibromyalgia?

ADHD can present differently in different people. The symptoms are usually split into two main categories: inattentiveness, and hyperactivity and impulsiveness.

Inattentiveness can show up as difficulty concentrating and focusing, such as being easily distracted, forgetful, careless, and struggle to stay organized. Hyperactivity and impulsiveness often shows up as fidgeting, being overly talkative, interrupting people, and acting without thinking.

People with fibromyalgia often experience what's known as "brain fog" or "fibro fog." These cognitive symptoms include feeling confused, struggling to think clearly, concentrate, focus and remember things. These issues come from prefrontal cortex dysfunction3, and can be exacerbated by fatigue and being in pain.

These problems can look a lot like what people with chronic fatigue syndrome and ADHD deal with.

It's not just a coincidence that these conditions seem similar. New research has started to show that these issues might be connected, due to something going on in the brain that has to do with a chemical called dopamine.

Fibromyalgia & ADHD impact on the dopamine system

Both fibromyalgia and ADHD are linked to problems with how certain brain chemicals work. This is especially true for dopamine, which is heavily involved in feelings of pleasure and motivation, as well as memory, sleep, learning, and concentration, among other body functions. Sound familiar? This could mean they both conditions share a common issue with how this brain chemical functions.

It's not only dopamine. Serotonin and norepinephrine play a role in both conditions too.

Recent studies also link both ADHD and fibromyalgia to brain inflammation5, which implies that there could be more links between the two.

Is it fibromyalgia brain fog or is it ADHD? How can you tell?

Because of the overlap of cognitive symptoms in ADHD and fibromyalgia, it can be hard to work out which is causing your mental challenges.

The key difference between fibro brain fog and ADHD brain fog is that fibro fog can fluctuate significantly day-to-day, while ADHD brain fog is likely to be more consistent.

In addition, fibromyalgia is primarily a pain disorder. If you have widespread pain alongside your fogginess, and find that the two usually go together, it's most likely that fibro is the cause. On the other hand, ADHD might involve hyperactivity or impulsivity that is not typical of fibromyalgia, and doesn't cause pain.

That said, it is possible to have both conditions.

The prevalence of ADHD in fibromyalgia patients

Studies have found a link between ADHD and fibromyalgia. Many people who live with fibromyalgia also show adult ADHD symptoms.

in studies, 32.3% of women with fibromyalgia had childhood ADHD, much higher than the general 5 to 7% rate of ADHD in the general population. ADHD is four times more common in those with fibromyalgia (29.5%) than in those without (7.4%). This data indicates a strong connection between early ADHD symptoms and fibromyalgia development later4. Although it doesn't mean that having one definitely means you will develop the other.

Identifying genetic & environmental factors

Both ADHD and fibromyalgia appear to have a genetic component, notably involving variations in the gene associated with the dopamine D4 receptor6,7.

This genetic predisposition may increase the likelihood of developing either or both conditions. However, genetics might only be part of the story.

The exact causes of ADHD are currently unknown but it is thought that, in addition to genetics, exposure to certain environmental toxins, substances while in the womb, and premature birth might increase someone's risk of developing ADHD.

For fibromyalgia, environmental factors that can be significant include persistent stress, trauma, disrupted sleep cycles, infection and imbalances in your hormones and diet.

Adult ADHD symptoms can increase fibromyalgia symptoms

While some studies suggest that people with ADHD have reduced pain perception, other studies have found the opposite to be true8. And the co-occurrence of fibromyalgia and adult attention deficit hyperactivity disorder symptoms often leads to a more pronounced intensity of fibromyalgia symptoms and a greater challenge in managing daily activities.

Treating ADHD & fibromyalgia

Creating an effective treatment plan for those grappling with the simultaneous challenges of ADHD and fibromyalgia involves a tailored approach, using both medicine and other kinds of therapy to help with all the different symptoms they have. Using the same treatment for everyone won't work for the complex symptoms that come with having both conditions.

Medication

Medication is just one part of a broader approach to pain management and should be used in conjunction with other pain control strategies that include educational, lifestyle, and psychological support.

Some antidepressants can help with both ADHD and fibromyalgia. In one study, a patient with ADHD and fibromyalgia took atomoxetine, which is usually prescribed to help improved attention in ADHD. The patient reported that this their fibromyalgia pain reduced by 60%, in addition to improvements in their daily functioning and a reduction in the interference of ADHD symptoms9. It's important to note that one person's experience cannot be used as scientific proof. However, this anecdotal account is an interesting starting point for future studies on medicines that impact neurochemical processes related to attention regulation and pain perception.

The types of medications often recommended for fibromyalgia include:

  • non-prescription pain relievers like aspirin and ibuprofen
  • antidepressants, for example, amitriptyline and duloxetine, which can both alleviate pain and enhance mood
  • modulators of pain and inflammation, such as Low Dose Naltrexone (LDN)
  • medications originally developed for epilepsy, such as pregabalin and gabapentin, are also used to calm an overly reactive nervous system.

Consulting your healthcare provider is crucial for tailoring medication choices to your unique health needs.

Retraining your pain

Understanding that pain is not just about feeling hurt physically, but also involves your feelings and relationships with others. This holistic approach is important for changing how your brain thinks about pain.

A key part is to figure out what makes your pain start – perhaps it's stress, certain thoughts, or some part of your lifestyle. Once you know what causes the pain, you can work on changing these things by eating better, sleeping more, exercising, or using special techniques to train your brain to deal with pain differently.

Stress management

While stress is an inevitable aspect of daily life, it can have a pronounced effect on those with fibromyalgia, often intensifying their pain. While completely eliminating stress may not be feasible, mastering the art of managing and reducing stress is a realistic and worthwhile objective.

Employing strategies like cognitive behavioral therapy (CBT), mindfulness meditation, and various relaxation techniques can play a significant role in lessening the physiological impact of stress.

If you have ADHD, although it may be initially challenging to adopt these practices, persistent application and commitment can lead to a gradual reshaping of your brain, diminishing the severity of your symptoms and their influence on your life.

CBT tailored for fibromyalgia typically includes:

  • educational sessions to deepen understanding of fibromyalgia
  • skills development for enhanced pain management and functional improvement
  • practical application of these skills in everyday situations.

Cultivating a strong support system, including friends, therapists, or a compassionate community, is vital for those with fibromyalgia, offering emotional support and solace during times of increased stress.

Physical movement

Although it may sound daunting, integrating a level of movement that you feel comfortable with – especially if you can include some aerobic exercises and some strength training into your routine – you can significantly reduce the intensity of your pain, while also combating psychological issues like depression.

This whole person approach to symptom management advocates for a diverse mix of cardiovascular and other fitness activities, recognized for improving physical functionality and mitigating other symptoms.

More information

At MoreGoodDays®, we use a special plan to help you deal with fibromyalgia. We know fibromyalgia can really change how you live, so we've found different ways to help. We offer learning materials and tips on how to understand fibromyalgia better and ways to make the pain and tiredness easier to handle.

Together, we're committed to helping you lead a healthier, happier life despite the challenges of fibromyalgia.

Download our mobile app for free from the Apple App Store or Google Play Store for immediate access to some of our content and to see your support options.

  1. Buskila D, Cohen H. Comorbidity of fibromyalgia and psychiatric disorders. Curr Pain Headache Rep. 2007 Oct;11(5):333-8. doi: 10.1007/s11916-007-0214-4. PMID: 17894922. https://pubmed.ncbi.nlm.nih.gov/17894922/
  2. Clauw D, Sarzi-Puttini P, Pellegrino G, Shoenfeld Y. Is fibromyalgia an autoimmune disorder? Autoimmun Rev. 2023 Aug 25:103424. doi: 10.1016/j.autrev.2023.103424. Epub ahead of print. PMID: 37634681. https://pubmed.ncbi.nlm.nih.gov/37634681/
  3. Yılmaz E, Tamam L. Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia. Neuropsychiatr Dis Treat. 2018 Jul 24;14:1883-1889. doi: 10.2147/NDT.S159312. PMID: 30100723; PMCID: PMC6063452. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063452/
  4. Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021 Apr 9;22(8):3891. doi: 10.3390/ijms22083891. PMID: 33918736; PMCID: PMC8068842. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068842/
  5. Battison EAJ, Brown PCM, Holley AL, Wilson AC. Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review. Children (Basel). 2023 Jan 11;10(1):142. doi: 10.3390/children10010142. PMID: 36670692; PMCID: PMC9857366. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9857366/
  6. Buskila D, Cohen H, Neumann L, Ebstein RP. An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits. Mol Psychiatry. 2004 Aug;9(8):730-1. doi: 10.1038/sj.mp.4001506. Erratum in: Mol Psychiatry. 2004 Oct;9(10):973. Dan, B [corrected to Buskila, D]; Hagit, C [corrected to Cohen, H]; Lily, N [corrected to Neumann, L]. PMID: 15052273. https://pubmed.ncbi.nlm.nih.gov/15052273/
  7. Martel MM, Nikolas M, Jernigan K, Friderici K, Waldman I, Nigg JT. The dopamine receptor D4 gene (DRD4) moderates family environmental effects on ADHD. J Abnorm Child Psychol. 2011 Jan;39(1):1-10. doi: 10.1007/s10802-010-9439-5. PMID: 20644990; PMCID: PMC4306231. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306231/
  8. Bozkurt A, Balta S. The effect of methylphenidate on pain perception thresholds in children with attention deficit hyperactivity disorder. Child Adolesc Psychiatry Ment Health. 2023 Oct 13;17(1):118. doi: 10.1186/s13034-023-00667-y. PMID: 37833816; PMCID: PMC10576289. https://pubmed.ncbi.nlm.nih.gov/37833816/
  9. Yakov Vorobeychik & Martin A. Acquadro (2008) Use of Atomoxetine in a Patient with Fibromyalgia Syndrome and Attention-Deficit Hyperactivity Disorder, Journal of Musculoskeletal Pain, 16:3, 189-192, DOI: 10.1080/10582450802161960

ADHD & Fibromyalgia: Understanding the Overlapping Challenges

Table of contents

ADHD & Fibromyalgia: Understanding the Overlapping Challenges

Is there a connection between attention deficit hyperactivity disorder (ADHD) and fibromyalgia?

This article aims to clarify the relationship between these two conditions, delve into the environmental and genetic factors involved, and explain why fibromyalgia encompasses more than just "brain fog." Additionally, we'll offer strategies for managing the symptoms of both ADHD and fibromyalgia.

What is fibromyalgia?

Fibromyalgia, a complex chronic pain disorder, is closely linked to a phenomenon referred to as central sensitization. Those with the condition experience widespread musculoskeletal pain, profound fatigue, and sleep and mood disturbances.

Central sensitization occurs when the nervous system goes into overdrive, maintaining a state of heightened reactivity that accentuates pain. The brain and spinal cord turn up the volume on stimuli and sensations, so that even normal touch or pressure can be perceived as painful.

Fibromyalgia co-morbidity

Fibromyalgia can exist alongside various other health conditions, and studies show people who live with fibromyalgia are significantly more likely to experience other physical and psychological conditions compared to the general population.

Common conditions include:

  • Musculoskeletal conditions: These include chronic pain conditions such as headaches, migraines, and temporomandibular joint (TMJ) dysfunction
  • Neuropsychiatric conditions: Depression, anxiety, ADHD and sleep disturbances1.
  • Other chronic conditions: Irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), and certain autoimmune diseases such as rheumatoid arthritis and lupus2.

How closely linked are ADHD & fibromyalgia?

ADHD can present differently in different people. The symptoms are usually split into two main categories: inattentiveness, and hyperactivity and impulsiveness.

Inattentiveness can show up as difficulty concentrating and focusing, such as being easily distracted, forgetful, careless, and struggle to stay organized. Hyperactivity and impulsiveness often shows up as fidgeting, being overly talkative, interrupting people, and acting without thinking.

People with fibromyalgia often experience what's known as "brain fog" or "fibro fog." These cognitive symptoms include feeling confused, struggling to think clearly, concentrate, focus and remember things. These issues come from prefrontal cortex dysfunction3, and can be exacerbated by fatigue and being in pain.

These problems can look a lot like what people with chronic fatigue syndrome and ADHD deal with.

It's not just a coincidence that these conditions seem similar. New research has started to show that these issues might be connected, due to something going on in the brain that has to do with a chemical called dopamine.

Fibromyalgia & ADHD impact on the dopamine system

Both fibromyalgia and ADHD are linked to problems with how certain brain chemicals work. This is especially true for dopamine, which is heavily involved in feelings of pleasure and motivation, as well as memory, sleep, learning, and concentration, among other body functions. Sound familiar? This could mean they both conditions share a common issue with how this brain chemical functions.

It's not only dopamine. Serotonin and norepinephrine play a role in both conditions too.

Recent studies also link both ADHD and fibromyalgia to brain inflammation5, which implies that there could be more links between the two.

Is it fibromyalgia brain fog or is it ADHD? How can you tell?

Because of the overlap of cognitive symptoms in ADHD and fibromyalgia, it can be hard to work out which is causing your mental challenges.

The key difference between fibro brain fog and ADHD brain fog is that fibro fog can fluctuate significantly day-to-day, while ADHD brain fog is likely to be more consistent.

In addition, fibromyalgia is primarily a pain disorder. If you have widespread pain alongside your fogginess, and find that the two usually go together, it's most likely that fibro is the cause. On the other hand, ADHD might involve hyperactivity or impulsivity that is not typical of fibromyalgia, and doesn't cause pain.

That said, it is possible to have both conditions.

The prevalence of ADHD in fibromyalgia patients

Studies have found a link between ADHD and fibromyalgia. Many people who live with fibromyalgia also show adult ADHD symptoms.

in studies, 32.3% of women with fibromyalgia had childhood ADHD, much higher than the general 5 to 7% rate of ADHD in the general population. ADHD is four times more common in those with fibromyalgia (29.5%) than in those without (7.4%). This data indicates a strong connection between early ADHD symptoms and fibromyalgia development later4. Although it doesn't mean that having one definitely means you will develop the other.

Identifying genetic & environmental factors

Both ADHD and fibromyalgia appear to have a genetic component, notably involving variations in the gene associated with the dopamine D4 receptor6,7.

This genetic predisposition may increase the likelihood of developing either or both conditions. However, genetics might only be part of the story.

The exact causes of ADHD are currently unknown but it is thought that, in addition to genetics, exposure to certain environmental toxins, substances while in the womb, and premature birth might increase someone's risk of developing ADHD.

For fibromyalgia, environmental factors that can be significant include persistent stress, trauma, disrupted sleep cycles, infection and imbalances in your hormones and diet.

Adult ADHD symptoms can increase fibromyalgia symptoms

While some studies suggest that people with ADHD have reduced pain perception, other studies have found the opposite to be true8. And the co-occurrence of fibromyalgia and adult attention deficit hyperactivity disorder symptoms often leads to a more pronounced intensity of fibromyalgia symptoms and a greater challenge in managing daily activities.

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Treating ADHD & fibromyalgia

Creating an effective treatment plan for those grappling with the simultaneous challenges of ADHD and fibromyalgia involves a tailored approach, using both medicine and other kinds of therapy to help with all the different symptoms they have. Using the same treatment for everyone won't work for the complex symptoms that come with having both conditions.

Medication

Medication is just one part of a broader approach to pain management and should be used in conjunction with other pain control strategies that include educational, lifestyle, and psychological support.

Some antidepressants can help with both ADHD and fibromyalgia. In one study, a patient with ADHD and fibromyalgia took atomoxetine, which is usually prescribed to help improved attention in ADHD. The patient reported that this their fibromyalgia pain reduced by 60%, in addition to improvements in their daily functioning and a reduction in the interference of ADHD symptoms9. It's important to note that one person's experience cannot be used as scientific proof. However, this anecdotal account is an interesting starting point for future studies on medicines that impact neurochemical processes related to attention regulation and pain perception.

The types of medications often recommended for fibromyalgia include:

  • non-prescription pain relievers like aspirin and ibuprofen
  • antidepressants, for example, amitriptyline and duloxetine, which can both alleviate pain and enhance mood
  • modulators of pain and inflammation, such as Low Dose Naltrexone (LDN)
  • medications originally developed for epilepsy, such as pregabalin and gabapentin, are also used to calm an overly reactive nervous system.

Consulting your healthcare provider is crucial for tailoring medication choices to your unique health needs.

Retraining your pain

Understanding that pain is not just about feeling hurt physically, but also involves your feelings and relationships with others. This holistic approach is important for changing how your brain thinks about pain.

A key part is to figure out what makes your pain start – perhaps it's stress, certain thoughts, or some part of your lifestyle. Once you know what causes the pain, you can work on changing these things by eating better, sleeping more, exercising, or using special techniques to train your brain to deal with pain differently.

Stress management

While stress is an inevitable aspect of daily life, it can have a pronounced effect on those with fibromyalgia, often intensifying their pain. While completely eliminating stress may not be feasible, mastering the art of managing and reducing stress is a realistic and worthwhile objective.

Employing strategies like cognitive behavioral therapy (CBT), mindfulness meditation, and various relaxation techniques can play a significant role in lessening the physiological impact of stress.

If you have ADHD, although it may be initially challenging to adopt these practices, persistent application and commitment can lead to a gradual reshaping of your brain, diminishing the severity of your symptoms and their influence on your life.

CBT tailored for fibromyalgia typically includes:

  • educational sessions to deepen understanding of fibromyalgia
  • skills development for enhanced pain management and functional improvement
  • practical application of these skills in everyday situations.

Cultivating a strong support system, including friends, therapists, or a compassionate community, is vital for those with fibromyalgia, offering emotional support and solace during times of increased stress.

Physical movement

Although it may sound daunting, integrating a level of movement that you feel comfortable with – especially if you can include some aerobic exercises and some strength training into your routine – you can significantly reduce the intensity of your pain, while also combating psychological issues like depression.

This whole person approach to symptom management advocates for a diverse mix of cardiovascular and other fitness activities, recognized for improving physical functionality and mitigating other symptoms.

More information

At MoreGoodDays®, we use a special plan to help you deal with fibromyalgia. We know fibromyalgia can really change how you live, so we've found different ways to help. We offer learning materials and tips on how to understand fibromyalgia better and ways to make the pain and tiredness easier to handle.

Together, we're committed to helping you lead a healthier, happier life despite the challenges of fibromyalgia.

Download our mobile app for free from the Apple App Store or Google Play Store for immediate access to some of our content and to see your support options.