Is Fibromyalgia Actually Undiagnosed Adult ADHD

Hi Friend

Hope you have had a good week. As you maybe aware my practice is around helping complex fibromyalgia and ME patients. increasingly in my practice i have have been really checking to ensure adhd has not been missed in my patients.

Fibromyalgia (FM) is typically diagnosed as a chronic pain condition with fatigue, sleep issues, and cognitive complaints. ADHD (Attention Deficit Hyperactivity Disorder), by contrast, is a neurodevelopmental disorder defined by symptoms of inattention, impulsivity, and hyperactivity. On the surface, they seem unrelated.

However, emerging research and patient data suggest a significant and under-recognised overlap between these two conditions — with implications for diagnosis, treatment, and long-term outcomes.

🧠 Shared Symptomatology

🧩 1. Cognitive Dysfunction ("Fibro Fog")

• Fibromyalgia patients frequently report difficulties with working memory, sustained attention, planning, and task switching — classic features of executive dysfunction.

• These are not secondary to pain or sleep disturbance; neuropsychological testing reveals persistent deficits even when pain is controlled.

• In ADHD, executive dysfunction is primary and results from impaired activity in the prefrontal cortex, especially in dopaminergic circuits.

Clinical parallel: Many FM patients say, "I can't concentrate, I lose things, I can't finish tasks" — nearly identical to adult ADHD presentations.

🔄 2. Dopaminergic Dysregulation

Both ADHD and fibromyalgia involve dysfunction of dopamine and norepinephrine:

• ADHD: reduced dopaminergic tone in the prefrontal cortex → attention, reward, motivation issues.

• FM: impaired descending inhibitory pain pathways, partly modulated by dopamine, leading to central sensitization — heightened pain sensitivity and poor endogenous pain control.

📚 Evidence:

• SPECT and PET scans in FM patients show reduced dopamine receptor binding in pain-processing areas (e.g., nucleus accumbens, insula).

• This mirrors findings in ADHD brains, especially in reward and attention networks.

🧬 Neurobiological & Neuroinflammatory Crossroads

🌐 3. Central Sensitization and Neuroinflammation

• Fibromyalgia is increasingly seen as a central sensitivity syndrome, where the nervous system is hypersensitized to stimuli.

• ADHD also shows low-grade neuroinflammation, especially in microglial activation and HPA axis dysregulation.

These conditions may share:

• Increased cytokine activity (e.g., IL-6, TNF-alpha)

• Impaired glial cell regulation

• Altered stress reactivity and cortisol rhythms

📊 Epidemiology & Studies

🧪 Clinical Experience and Case Reports

• Some fibromyalgia patients experience significant symptom relief from ADHD medications (methylphenidate, atomoxetine, lisdexamfetamine).

• Benefits include improved energy, focus, emotional regulation, and sometimes reduced pain perception.

🧠 Why? Because:

• These medications enhance prefrontal cortical function and dopaminergic tone, which improves both executive function and descending pain modulation.

⚠️ Diagnostic Implications

• ADHD is frequently missed in adult women, especially those presenting with emotional dysregulation, fatigue, or anxiety — all common in FM.

• ADHD symptoms in fibromyalgia patients may be dismissed as secondary to pain or “fibro fog,” delaying diagnosis.

• Conversely, chronic pain and fatigue in ADHD patients may be ignored if they don’t meet fibromyalgia diagnostic criteria.

🩺 Treatment Implications

Consider screening for ADHD in fibromyalgia patients who report:

• Disorganization, forgetfulness, or procrastination from childhood

• Struggles with time management or emotional reactivity

• Relief of fatigue or fogginess with stimulants or caffeine

• Poor response to conventional fibromyalgia treatments alone

Treatment options for dual diagnosis:

• Non-stimulant medications: Atomoxetine (Strattera), bupropion

• Stimulants: Methylphenidate, lisdexamfetamine — with close monitoring

• Multimodal: Exercise, CBT, pacing, diet, and vagal tone support

💡 Conclusion

The link between fibromyalgia and ADHD is real, biologically plausible, and clinically relevant.

📍 Recognising ADHD in fibromyalgia patients may unlock better treatment strategies, improved cognitive function, and reduced symptom burden.

For some patients, ADHD is not just a comorbidity — it’s the missing link.

My Clinic Is now accepting patients again as I have now dedicated an extra week. I can see patients remote or in person in Peterborough (my preference). If interested please book below:

Best Wishes

Dr Ahmed