Fibromyalgia Brain-Fog

Thank you for this interest peaking question!

Fibromyalgia (FM) is a complex condition of which is still not fully understood. To enlighten those who don’t know much about it, FM affects approximately 2% of the Australian population with a peak incidence in young to middle aged women (1). It is classified as a syndrome and characterised by multiple, varied and fluctuating symptoms, and co-existing clinical conditions (table 1).

Table one: Symptoms and Co-existing conditions of Fibromyalgia

First part of question- the why’s & how’s of the condition known as “fibro-fog” that fibromyalgia sufferers get sometimes?

The syndrome is hallmarked by widespread somatic pain, specifically deep tissue tenderness, fatigue, sleep disturbances, cognitive dysfunctions and psychological distress. In respect to the question, the term “fibro-fog” (not dissimilar to “brain fog”) is a term used to describe symptoms of cognitive difficulties, such as, impaired memory, poor concentration and attention. Problems with memory and concentration has received a large amount of experimental study with some of the most robust deficits in memory and attention grounded in an impaired ability to remain focused with competing stimulus. Interestingly, FM patients are less able to retain information than healthy controls when rehearsal of information is prevented by distraction (2, 3, 4). This means that while people may feel their memory isn’t as good as it was, impairments in memory may actually be due to inattention or focusing issues rather than actual memory processes per se (5, 6, 7), i.e. memory processes may actually be fine, however, it’s the ability to stay focused so you can take in information that may be impaired. The practical implications here could be practicing activities that may help to improve attention and focus, e.g. mindfulness meditation.

The pathophysiology of fibromyalgia is underpinned by changes in the central nervous system (CNS). Indeed, neuroimaging studies show that CNS changes in grey matter and neurochemical abnormalities can explain (at least in part) the cognitive difficulties that FM patients complain of. Specifically, the medial frontal and anterior cingulate cortices structures in the brain’s grey matter, together with other structures, are known to be related to working memory processes. Neuroimaging have found that frontal grey matter is reduced in FM and experimental studies have found that losses in this grey matter is detrimental to working memory processes. For example, one study found that FM patients with detrimental changes grey matter areas (including structures of the brain responsible for higher-order cognitive functions, such as working memory, attention and decision making) had noticeably poorer scores compared to control groups on a working memory task (8).

Not only is there a decrease in grey matter and related structures, in terms of neurochemical abnormalities in FM, dopamine plays an important role in cognitive functioning. There is evidence to suggest that dysfunctional dopamine pathways in memory tasks, perceptual speed and response inhibition could also contribute to the cognitive symptoms of FM. Indirectly, fibro-fog could also be a “downstream” consequence of changes to other areas of the brain that present clinically as depression, chronic pain and sleep disturbances. For example, sleep is a protective factor against mood disturbances, pain sensitivity, and stress, all of which could contribute to feeling fatigued, a lack of concentration and attention (9)

Second part of question- can it be ameliorated (improved) or even prevented?

Fibro-fog cannot be prevented per se but there are a few management strategies that are known to help reduce severity (10). Firstly, the treatment of pain, depression, sleep disturbances and other fibromyalgia symptoms that have been linked to fibro-fog, in turn may improve cognitive performance. As mentioned earlier, working memory of those with FM seems to be mediated by distraction thus engaging in techniques to counteract interference from distraction seems logical, for example, rehearsing information using “inner speech” has been shown to improve working memory in FM (11). Other strategies that may help preserve working memory include writing things down concurrently or immediately after hearing it (like a phone number), and if you can control the environment of which you’re occupying, try to reduce distractions e.g. turn down/off music, radio or the TV. Exercise has been shown to help with many fibromyalgia symptoms (13, 14), specifically, exercise has been positively associated with cognitive attention, mental acuity, executive functioning and processing speed (12). Pharmacological strategies can also be considered and while there is controversy in the literature regarding pros and cons of medication, those medications that reduce pain may well also help to improve cognitive functions (10).

Management strategies to reduce Fibro-fog:

• Rehearse information using inner speech
• Reduce distractions by removing them (if possible)
• Record information down on paper or ask someone to text/message/email you so you have the information to refer to
• Any form of exercise! Following the Australian Guidelines of Physical Activity as best you can if preferable. For some, intense exercise can cause pain flares. Choose an exercise or activity that you can tolerate and slowly increase the intensity or frequency over time. The aim is to get your heart and breathing rate up, and for best effects, the exercise needs to be regular and performed over a longer time.
• Strategies that manage stress and anxiety that often accompanies cognitive impairments like mindfulness, meditation, cognitive behavioural therapy (CBT).
• Talk to your GP or specialist about pharmacological/drug interventions that are right for you.

If you have any further questions, please give our Infoline a call on 1800 011 041. 

You can also download our Infosheet on Fibromyalgia here.

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References

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2. Leavitt F, Katz RS. Distraction as a key determinant of impaired memory in patients with fibromyalgia. Journal of Rheumatology. 2006;33(1):127–132.
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9. Pemberton, R., & Tyszkiewicz, M. D. F. (2016). Factors contributing to depressive mood states in everyday life: a systematic review. Journal of affective disorders, 200, 103-110.
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