Among the various symptoms associated with fibromyalgia, one of the most frustrating and pervasive is brain fog. Brain fog, or “fibro fog,” refers to a collection of cognitive symptoms that include poor memory, difficulty concentrating, mental fatigue, and a general sense of cloudiness or confusion.
While brain fog is not officially recognized as a medical diagnosis on its own, this constellation of cognitive symptoms is part of the diagnostic criteria for fibromyalgia, as it is a hallmark of the condition and significantly impacts quality of life.
But why is brain fog part of fibromyalgia, and what can patients do to get relief?
What is Fibromyalgia?
Fibromyalgia is a chronic condition that causes widespread pain throughout the body, often accompanied by fatigue, sleep disturbances, and emotional distress. The root cause of fibromyalgia is still unclear, but the underlying mechanism or pathophysiology is related to amplified pain signals in the brain and spinal cord.
This phenomenon, referred to as “central sensitization,” causes an increased sensitivity to pain. Individuals with fibromyalgia may experience pain from stimuli that would not typically cause discomfort, such as light touch or gentle pressure.
Fibromyalgia is often diagnosed when individuals experience widespread pain for at least three months, accompanied by additional symptoms such as poor sleep, cognitive disturbances, and mood disorders like anxiety and depression. It is important to note that fibromyalgia is not a progressive condition and does not lead to joint or muscle damage, though the severity of symptoms can vary over time, particularly in times of physical or psychological stress.
Why Brain Fog is a Part of Fibromyalgia
Although pain is the primary symptom of fibromyalgia, brain fog and fatigue are characteristic of the condition as well. This is different from other chronic conditions like arthritis, which don’t have a cognitive component.
In a 2021 study published in PLoS One, patients with fibromyalgia and rheumatoid arthritis, with similar pain severity, were given the same cognitive tasks. Fibromyalgia patients exhibited longer reaction times and made more attention-based errors on their tasks, while arthritis patients responded similarly to a healthy control.1
Why is this? Some of the main reasons why brain fog occurs in fibromyalgia include:
1. Central Sensitization
One of the central features of fibromyalgia is central sensitization, a process where the brain and spinal cord become hyper-reactive to sensory input. This means that the nervous system amplifies pain signals and other stimuli, even in the absence of physical injury.
This heightened sensitivity does not only amplify the perception of pain but can also extend to other sensations, including cognitive function. Research has shown that individuals with fibromyalgia have increased brain activity, particularly in areas associated with pain processing and cognitive functioning. This may lead to cognitive symptoms such as poor memory, concentration difficulties, and mental fatigue, all of which contribute to brain fog.
2. Sleep Disturbances
Many individuals with fibromyalgia also experience fatigue and significant sleep disturbances, including difficulty falling asleep, staying asleep, and experiencing restorative sleep. This lack of quality sleep exacerbates cognitive issues, as restorative sleep is essential for memory consolidation, problem-solving, and overall cognitive function.
3. Stress and Emotional Distress
Chronic pain, fatigue, and other symptoms of fibromyalgia can lead to significant emotional distress, including anxiety and depression. These mental health issues are known to have a negative impact on cognitive functioning.
Stress, in particular, is a well-documented factor that can worsen brain fog by impairing the brain’s ability to focus, retain information, and think clearly. Research has shown that prolonged stress can lead to changes in the brain’s structure, particularly in regions associated with memory and decision-making.2 The mental load of living with chronic pain conditions like fibromyalgia can be stressful in themselves, increasing the potential for chronic brain fog.
In a study published in Frontiers in Psychology in 2018, researchers found that fibromyalgia patients who experienced higher levels of depression and anxiety had significantly more severe cognitive dysfunction, including issues with attention and memory. This suggests that the emotional toll of fibromyalgia may exacerbate the cognitive challenges associated with brain fog.3
Strategies for Managing Brain Fog in Fibromyalgia
While brain fog in fibromyalgia can be debilitating, there are strategies that people with fibro can use to manage and mitigate its effects. These strategies focus on reducing cognitive load for day-to-day tasks, focusing on sleep, having a pain management plan, and building a stress-reduction toolkit.
Below are some evidence-based approaches that may help with brain fog in fibromyalgia:
1. Reducing Cognitive Load
One of the reasons brain fog can be frustrating for so many people with fibromyalgia is because of the way it interrupts normal life and tasks. Instead of concentrating for long periods, someone experiencing fibro fog may find themselves unable to focus or remember what was on the agenda for the day.
Fibro coach Tami Stackelhouse recommends reducing cognitive load to help account for brain fog, which can improve overall quality of life as well as reduce symptoms longer term. This may include techniques like:
- Using reminder tools: To-do lists, calendars, timers and GPS, even when you don’t think they’re needed, can help reduce the mental burden of multitasking so you can focus on the task at hand
- Trying the Pomodoro method: Take breaks between tasks. Modify the usual 25 minutes of work and 5 minutes of break to shorter work times and longer breaks.
- Create a flare survival plan: When you’re in a symptom flare, it’s next to impossible to access the tools you need if they’re not right in front of you. Before you’re in a flare, consider what tools and support you find particularly helpful, whether it’s a soothing meditation or a loved one who can support you.
2. Improving Sleep Quality
Given that poor sleep is one of the primary contributors to brain fog in fibromyalgia, addressing sleep disturbances is a top priority. Several strategies can help improve sleep quality:
- Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I is an evidence-based approach to treating insomnia and has been shown to improve sleep in individuals with fibromyalgia. A study published in The Journal of Behavioral Medicine in 2014 found that CBT-I significantly improved sleep quality and overall daily functioning in fibromyalgia patients.4
- Sleep Hygiene Practices: Good sleep hygiene is essential for improving sleep quality. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting screen time before bed, and keeping the sleep environment cool, dark, and quiet.
- Relaxation Techniques: Practices such as deep breathing, progressive muscle relaxation, heat therapy, and mindfulness meditation can help reduce stress and promote relaxation, making it easier to fall asleep and stay asleep.
3. Pain Management Strategies
The daily effort of living in chronic pain is a stressor itself and takes a cognitive toll, so effective pain management is crucial for reducing the mental load that contributes to brain fog.
Fibromyalgia patients often use a combination of pharmacological and non-pharmacological interventions to manage pain. Although a fibromyalgia treatment plan may be personalized to the individual patients’ symptoms and goals, elements may include:
- Medications: There are no FDA-approved medications specifically for brain fog related to fibromyalgia. However, certain medications, such as duloxetine, pregabalin and low dose naltrexone, have been shown to be effective in reducing pain and improving sleep in fibromyalgia patients, which can in turn help with cognitive processing. Some medications for fibromyalgia can cause cognitive disturbances as a side effect, so working with experienced fibromyalgia clinicians to determine the best course of treatment is essential.
- Movement: Regular physical activity has been shown not only to reduce pain, but also improve cognitive function in fibromyalgia specifically. A randomized controlled trial published in Clinical Physiology and Functional Imaging in 2017 found that patients who participated in a 15-week movement program experienced significant improvements in cognitive performance.5
- Behavioral Therapy and Mindfulness: Chronic stress exacerbates brain fog, so it is essential for individuals with fibromyalgia to manage stress effectively and increase their ability to deal with negative behaviorals when they arise. Behavioral and mindfulness-based interventions, such as meditation, have been shown to reduce stress, improve cognitive functioning, and increase overall wellbeing in people with fibromyalgia.6 A study of Stanza, an app-based behavioral therapy for fibromyalgia, looked specifically at the cognitive symptoms associated with fibro; it found that 68% of patients improved in memory and concentration after the program.7
Summary
Fibromyalgia is a complex condition that affects not only the body but also the brain. Brain fog is a common and frustrating symptom of fibromyalgia, affecting cognitive function, memory, and concentration. While the exact cause of brain fog in fibromyalgia is not fully understood, factors such as central sensitization, sleep disturbances, and emotional distress all play a role in its development.
However, there are several strategies available to help manage brain fog, including improving sleep quality, effectively managing pain, and arming yourself with techniques to reduce cognitive load. With the right combination of tools, people with fibromyalgia can improve their quality of life and reduce the impact of brain fog on their daily functioning.
Sources
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2 McEwen BS, Sapolsky RM. Stress and cognitive function. Curr Opin Neurobiol. 1995 Apr;5(2):205-16. doi: 10.1016/0959-4388(95)80028-x. PMID: 7620309.
3 Galvez-Sánchez CM, Reyes Del Paso GA, Duschek S. Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem. Front Psychol. 2018 Mar 22;9:377. doi: 10.3389/fpsyg.2018.00377. PMID: 29623059; PMCID: PMC5874325.
4 Martínez MP, Miró E, Sánchez AI, Díaz-Piedra C, Cáliz R, Vlaeyen JW, Buela-Casal G. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med. 2014 Aug;37(4):683-97. doi: 10.1007/s10865-013-9520-y. Epub 2013 Jun 7. PMID: 23744045.
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6 Gendreau, R Michael et al. Self-guided digital behavioural therapy versus active control for fibromyalgia (PROSPER-FM): a phase 3, multicentre, randomised controlled trial. The Lancet, Volume 404, Issue 10450, 364 – 374
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