Patients with fibromyalgia may screen positive for ADHD
Thursday, February 08, 2018
Fibromyalgia (FM) is one of the most common pain conditions, characterized with diffuse aching, pain or stiffness in the muscles or joints and accompanied by multiple tender points on examination. It affects 10 million people in the United States and an estimated 3-6 percent of the world population. About 75-90 percent of those who suffer with FM are women.
Some researchers link FM and depression, and it has been shown that those with FM are up to three times more likely to have depression than those without. Other researchers point to abnormalities that alter activity of neurotransmitters involved in pain sensitivity, such as dopamine, serotonin and noradrenaline.
FM may significantly impact an individual's functioning due to the presence of chronic pain, fatigue and cognitive impairment. The impact of FM on quality of life can be devastating with symptoms of fatigue, sleep disturbance, morning stiffness and high levels of anxiety. FM also can have a negative impact on personal relationships, careers and mental health.
Attention deficit hyperactivity disorder (ADHD), a chronic neurodevelopmental disorder also associated with impaired cognition and dopaminergic function, has similar cognitive symptoms to FM. In fact, ADHD is commonly mistaken with anxiety, depression and other behavioral disorders.
In an outpatient psychiatric clinic, some adult patients who presented primarily with symptoms of ADHD, predominately inattentive type, also reported unexplained fatigue, widespread musculoskeletal pain or a pre-existing diagnosis of chronic fatigue syndrome (CFS) or FM. One previous report showed an association between FM and a polymorphism of the dopamine D4 receptor and its relationship to novelty seeking personality traits, symptoms similar to those of ADHD.
Roland van Rensburg, MBChB, who is in private practice in Lyttelton, South Africa, and colleagues. recruited 123 patients (88 percent female, average age, 50 years) who had been previously diagnosed with FM at a chronic pain practice to assess the potential co-occurrence of FM and ADHD.
Patients were screened for adult ADHD using the World Health Organization Adult ADHD Self Report scale v1.1. The Revised Fibromyalgia Impact Questionnaire (FIQ-R) was used to assess the impact of FM. Cognitive assessment was based on self-report in accordance with the 2011 modified American College of Rheumatology criteria and the FIQ-R, respectively.
Of the 123 participants, 55 screened positive for adult ADHD. Participants with both FM and a positive adult ADHD screening test scored higher on the FIQ-R score (64.74 vs. 54.10). Self-reported cognitive impairment was rated higher in the combined group. In addition, 91 percent of FM patients who were found to have ADHD also screened positive for anxiety, markedly more than in the FM-only group (71 percent).
FM is a complex illness to diagnose and treat, with symptoms that may be part of or overlap with other diseases or syndromes. According to van Rensburg, cognitive assessment has not been included as part of the FM diagnostic criteria, so the overlap of FM and cognitive impairment may be underestimated and underreported.
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