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.
🧩 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
Study | Sample | Key Findings |
|---|---|---|
Hassett et al., 2011 | 123 FM patients | 25–40% met criteria for adult ADHD using validated scales |
Bou Khalil et al., 2015 | Case-control | ADHD symptoms in FM patients correlated with depression, fatigue, and poor coping |
CNS Spectrums, 2018 | Literature review | FM may represent a “pain-related subtype” of adult ADHD |
Chouinard et al., 2012 | Clinical case series | ADHD meds improved pain, fatigue, and cognition in FM patients with comorbid ADHD |
🧪 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
