ADHD and Fibromyalgia
Are they linked?
Below is a summary of literature on various aspects of the ADHD and fibromyalgia overlap / cooccurrence. As I have a huge unorganised body of literature to get through, this summary will be updated on an ongoing basis, with the aim of providing background and context. I would also welcome links to any resources via email or the Facebook group.
Prevalence of ADHD in people with fibromyalgia, and vice versa:
Retrospective diagnosis of childhood ADHD in women with fibromyalgia:
Yilmaz and Tamam (2018) found that 33.3% of 78 female participants with fibromyalgia screened positive (self-reported) for childhood ADHD, which is similar to the 32.3% of 201 participants who fulfilled DSM-IV criteria for ADHD in a study by Reyero et al. (2011).
Diagnosis of ADHD (or chronic pain) in adults with fibromyalgia:
Yilmaz and Tamam (2018) also found that 29.5% of their 78 female participants screened positive for adult ADHD. However, a mixed gender study by Van Rensburg et al. (2018) of 123 adults with fibromyalgia, suggested a higher prevalence, of 44.7% who screened positive (self-reported) for ADHD.
In Pallanti, Porta and Salerno (2021), 24.5% of 106 female participants with fibromyalgia met DSM-VI-TR diagnostic criteria for adult ADHD. This is similar to Derksen, Vreeling and Tchetverikov (2015), in which 25% of participants with fibromyalgia also had adult ADHD (clinical assessment).
A study by Asztély et al. (2019), with 100 female participants who had ADHD and / or autism (initially aged from three to 18 years, and then followed up 16 to 19 years later), found that 77% of participants experienced chronic pain. Of those with a main diagnosis of ADHD, 39% reported their pain to be ‘widespread’.
A study by Golimstok et al. (2015) looked for fibromyalgia among older adults (aged 71+) and found it in 24.7% of 154 participants with ADHD, compared to 4.6% of 262 participants with a ‘cognitive complaint’, and 0% of 71 healthy controls. Although around 60% of participants in each group were female, all who were found to have fibromyalgia were female, except for one male, who was in the ADHD group.
Relationship between ADHD traits and pain / fibromyalgia:
A study by Stickley et al. (2016) used data from a representative sample of the UK general population (7,403 participants, aged over sixteen) and found a positive correlation between ADHD traits and pain.
Elboğa et al. (2019) found that 37.6% of 101 participants with fibromyalgia had an ‘attention deficit’, compared to 0% of ‘healthy’ controls. Miró et al. (2015), who had 77 participants in their study, found that ‘attention deficit’ was associated with worse daily functioning in women with fibromyalgia but not in men. Karaş et al. (2020) found that childhood ADHD traits contributed to poorer functioning in their 64 female participants with fibromyalgia.
Health-Related Quality of Life (HRQoL) in people with ADHD
Studies into health-related quality of life (HRQoL) in adults with ADHD found it to be consistently lower than in adults without ADHD. Ahnemark (2018) found that 19% of 189 participants with ADHD reported ‘pain’. In a study by Lensing et al. (2015), 17.4% of148 participants with ADHD had a fibromyalgia diagnosis. Fuller-Thomson, Lewis and Agbeyaka (2016) found that 28% of 107 women with ADHD reported ‘chronic pain’, compared to 8.5% of 3801 without ADHD.
Speculation on the link between ADHD and chronic pain:
There are several compelling theories on how ADHD and pain / fibromyalgia might be linked. However, none of the theories can explain why only some people are affected by both conditions.
Increased risk of injury:
People with ADHD are more accident-prone and susceptible to injuries and dopamine is involved in ADHD core symptoms and pain perception (Wolff et al., 2016):
‘We suggest that reduced pain perception in children and adolescents with ADHD not medicated with MPH may lead to higher risk tolerance by misjudgments of dangerous situations, expanding the importance of MPH administration in affected children and adolescents.’ (Wolff et al., 2016, p.1)
Cognitive profile:
‘The profile of cognitive symptoms in FMS and ADHD is very similar, and ADHD is commonly mistaken with anxiety, depression and other behavioural disorders, which are comorbidities of FMS. FMS and ADHD are part of a family of related disorders known as affective spectrum disorders. These disorders share physiologic abnormalities and genetic risk factors that may be central to their (a)etiology.(Golimstok et al., 2015, p.62).
Dopamine:
There is an article by Dan et al., (2004) titled ‘An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits’. I am not able to access the full article, but Golimstok et al. (2015, p.62) refer to their finding of ‘an overlap in clinical features and neurobiological substrate’
Chronic fatigue:
Young (2013) suggests that, over time, ADHD inattention might evolve into a syndrome of chronic fatigue and pain.
Affective spectrum disorders:
Goldenberg (2008) refers to the work of Hudson et al. (2004), who suggest that fibromyalgia and ADHD are two of the fourteen ‘affective spectrum disorders’ which they hypothesise as sharing ‘common physiologic abnormalities’.
Motor problems and high muscle tone in people with ADHD:
Motor regulation problems and pain in adults diagnosed with ADHD - PMC (nih.gov)
Joint hypermobility:
References:
Ahnemark, E. (2018) ‘Health-related quality of life and burden of illness in adults with newly diagnosed attention-deficit/hyperactivity disorder in Sweden’, p. 11.
Asztély, K., Kopp, S., Gillberg, C., Waern, M. and Bergman, S. (2019) ‘Chronic pain and health-related quality of life in women with autism And/or ADHD: A prospective longitudinal study’, Journal of Pain Research, vol. 12, pp. 2925–2932 [Online]. DOI: 10.2147/JPR.S212422.
Dan, B., Hagit, C., Lily, N. and Ebstein, R.P. (2004) ‘An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits’, Molecular Psychiatry, 9(8), pp. 730–731. doi:10.1038/sj.mp.4001506.
Derksen, M. T., Vreeling, M. J. W. and Tchetverikov, I. (2015) ‘High frequency of adult attention deficit hyperactivity disorder among fibromyalgia patients in the Netherlands: should a systematic collaboration between rheumatologists and psychiatrists be sought?’, Clinical and Experimental Rheumatology, vol. 33, no. 1 Suppl 88, p. S141.
Elboğa, G., Akaltun, M. S., Altındağ, Ö., Altındağ, A., Aydeniz, A., Gürsoy, S. and Gür, A. (2019) ‘Alexithymia and attention deficit and their relationship with disease severity in fibromyalgia syndrome’, Turkish Journal of Physical Medicine and Rehabilitation, vol. 66, no. 2, pp. 134–139 [Online]. DOI: 10.5606/tftrd.2020.2926.
Fuller-Thomson, E., Lewis, D. A. and Agbeyaka, S. K. (2016) ‘Attention-deficit/hyperactivity disorder casts a long shadow: findings from a population-based study of adult women with self-reported ADHD: ADHD and women’, Child : care, health & development, vol. 42, no. 6, pp. 918–927 [Online]. DOI: 10.1111/cch.12380.
Goldenberg, D. (2008) ‘Understanding fibromyalgia and its related disorders.’, Primary care companion to the Journal of clinical psychiatry [Preprint]. doi:10.4088/pcc.v10n0208.
Golimstok, A., Fernández, M., MM, G., García Basalo, M., Cámpora, N., Berrios, W., Rojas, J. and Cristiano, E. (2015) ‘Adult Attention-Deficit and Hyperactivity Disorder and Fibromyalgia: A Case-Control Study’, Neuro - Open Journal, vol. 2, pp. 61–66 [Online]. DOI: 10.17140/NOJ-2-114.
Karaş, H., Çetingök, H., İlişer, R., Çarpar, E. and Kaşer, M. (2020) ‘Childhood and adult attention deficit hyperactivity disorder symptoms in fibromyalgia: associations with depression, anxiety and disease impact’, International Journal of Psychiatry in Clinical Practice, vol. 24, no. 3, pp. 257–263 [Online]. DOI: 10.1080/13651501.2020.1764585.
Lensing, M. B., Zeiner, P., Sandvik, L. and Opjordsmoen, S. (2015) ‘Quality of Life in Adults Aged 50+ With ADHD’, Journal of Attention Disorders, SAGE Publications Inc, vol. 19, no. 5, pp. 405–413 [Online]. DOI: 10.1177/1087054713480035.
Miró, E., Martínez, M. P., Sánchez, A. I., Prados, G. and Lupiáñez, J. (2015) ‘Men and women with fibromyalgia: Relation between attentional function and clinical symptoms’, British Journal of Health Psychology, vol. 20, no. 3, pp. 632–647 [Online]. DOI: 10.1111/bjhp.12128.
Pallanti, S., Porta, F. and Salerno, L. (2021) ‘Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities’, Journal of Psychiatric Research, vol. 136, pp. 537–542 [Online]. DOI: 10.1016/j.jpsychires.2020.10.027.
Reyero, F., Ponce, G., Rodriguez-Jimenez, R., Fernandez-Dapica, P., Taboada, D., Martin, V., Navio, M., Jimenez-Arriero, M. A., Hoenicka, J. and Palomo, T. (2011) ‘High frequency of childhood ADHD history in women with fibromyalgia’, European Psychiatry, vol. 26, no. 8, pp. 482–483 [Online]. DOI: 10.1016/j.eurpsy.2010.03.012.
Stickley, A., Koyanagi, A., Takahashi, H. and Kamio, Y. (2016) ‘ADHD Symptoms and Pain among Adults in England’, Psychiatry Research, Ireland, Elsevier BV, vol. 246, pp. 326–331 [Online]. DOI: 10.1016/j.psychres.2016.10.004.
Van Rensburg, R., Meyer, H. P., Hitchcock, S. A. and Schuler, C. E. (2018) ‘Screening for adult ADHD in patients with fibromyalgia syndrome’, Pain Medicine (United States), vol. 19, no. 9, pp. 1825–1831 [Online]. DOI: 10.1093/pm/pnx275.
Yilmaz, E. and Tamam, L. (2018) ‘Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia’, Neuropsychiatric disease and treatment, New Zealand, Informa UK Limited, Dove Medical Press Limited, Taylor & Francis Ltd, Dove Medical Press, vol. 14, pp. 1883–1889 [Online]. DOI: 10.2147/ndt.s159312.
Young, J.L. (2013) ‘Chronic Fatigue Syndrome: 3 Cases and a Discussion of the Natural History of Attention-Deficit/Hyperactivity Disorder’, Postgraduate Medicine, 125(1), pp. 162–168. doi:10.3810/pgm.2013.01.2631.