Cognition and Fibromyalgia

by Dr Smita Pandey Bhat 6/28/2010 10:48:00 AM
Cognition is the ability to think, perceive, know and understand the world. In psychology the cognition refers to mental functions, mental processes and states of intelligent entities. The particular focus is on comprehension, inferencing, decision- making, planning and learning. The term cognition is broadly the act of knowing that ends up in thought and action.


Introduction of Fibromyalgia:


Fibromyalgia is a chronic syndrome characterized by tiredness , pain in muscles, bones, joints and tender points.( Tender points are places  in the neck, shoulders, back, hips , arms and legs that hurt when touched)[2,3]. Fibromyalgia is taken from the Latin words (fibra+ myo+ algos).Fibra means fibre or fibrous tissues, myo means muscles and algos means pain. The term was coined in 1976.[4]It more affects females than males with a ration of 9:1. by ACR (American College of Rheumatology) criteria [5].Fibromyalgia can occur in 3 to 6% of population. The age of  onset is between 20 and 50, though it may occur in childhood as well.




The major symptoms of fibromyalgia are  widespread pain, tenderness to light touch, moderate to severe fatigue, heightened sensitivity to skin, tingling sensation achiness in the muscle tissues, prolonged muscle spasms, weakness in the limbs, and nerve pain and also chronic sleep disturbances. Other symptoms include headaches and facial pains,  depression, anxiety, mood changes, dizziness and difficulty concentrating etc.In addition to above symtoms the patients may experience cognitive dysfunctions as well.




The causes of this disease are unknown. There are several theories which state the causes of pain. One such theory is “central sensitization” which states that the people with fibromyalgia have lower threshold of pain because of the increased sensitivity that causes pain. Other theories state that the sleep disturbances, injuries, infections abnormalities of autonomic nervous systems( sympathetic nervous system dysfunction) and changes in muscle metabolism (reduced blood flow to muscles) etc can cause fibromyalgia. Also , psychological stress. and hormonal changes may cause fibromyalgia.The increased psychosocial stress, excessive physical exertion, and lack of slow- wave sleep and changes in humidity and barometric pressure  may exacerbate the symptoms.


Risk factors:


The risk factors include the female sex , early and middle adulthood, disturbed sleep patterns, family history and rheumatic disease.



The drug treatment include analgesics, antidpressants, anti-seizure drug and muscle relaxants. The non drug treatment includes physical exercises, massage treatment , stress management, cognitive behavior therapy and neurofeedback  or biofeedback. Holistic treatment include management of sleep, diet, stress, pain , managing blood sugar levels and  avoiding known triggers etc.


Fibromyalgia and Cognition:


 The patient may experience cognitive dysfunction ( known as “brain fog” or “fibro fog”) which may be characterized by impaired concentration, unclear thinking and short-term memory consolidation, impaired speed of performance, inability to multi-task, and cognitive overload.Fibro fog is the term descibed by Stuart Donaldson as "decreased ability to concentrate, decreased immediate recall, and an inability to multi-task". Other symptoms include confusion and forget fullness, inability to recall simple words and  transposing words and numbers. Sometimes cognitive functions are so impaired that they get lost in familiar places and they have difficulty in communication. Sometimes they lose their jobs or pediatric patients drop out of school . Also , there is difficulty in finding the right word for the conversation and they have trouble retaining new information.


Causes Of Cognitive Dysfunction In Fibromyalgia:

The patients with were studied on CT(SPECT) to visualize their brain. It was found that there was decreased blood flow in the right and left caudate nuclei and thalami.


Abnormal levels of neurotransmitters such as substance P, serotonin, dopamine, norepinephrine, and epinephrine may be cause cognitive dysfunction. Neuroendocrine imbalance of the HPA axis may play a role in fibro-fog.


The distracting quality of pain may be another possible cause of the cognitive dysfunction. Cognitive performance of patients with fibromyalgia is correlated with their reported level of pain.


Researchers are looking at tissue volumes in areas of the brain (hippocampus) that may be damaged by the effects of stress hormones.

The results of a study  by Elvin et al (2006) support the suggestion that muscle ischemia can contribute to pain in FM, possibly by maintaining the central nervous changes such as central sensitisation/disinhibition.[


Others studies have implicated yeast overload, water retention, and glial-cell abnormalities as causes of cognitive dysfunction in fibromyalgia.


Fibromyalgia, Sleep And Cognition:


Cote and Moldofsky (1997) studied 10 female patients with fibromyalgia   and a matched non compalinative comparison group. They spent two nights in the sleep laboratory. The subjects completed self assessment of a computerized battery and performance tests at hourly intervals from 7.0h to 20h.  The results indicated that fibromyalgia patients spent more time on stage 1 sleep. They reported greater sleepiness, more fatigue, more pain, more negative mood, and lower accuracy on performance tasks across a 14 h day. The Fibromyalgia group was slower in speed, but not impaired in accuracy, on performance of complex tasks, i.e., grammatical reasoning, serial addition/subtraction, and a simulated multi-task office procedure.



Dr Smita Pandey Bhat, Clinical Psychologist





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