Fibromyalgia is a complex health condition affecting about 4 million adults living in the United States. Among the various symptoms, one of the most puzzling and frustrating is a symptom known as “brain fog” or “fibro fog.”
Brain fog is a type of cognitive dysfunction that leaves you feeling like you’re in a constant mental haze. This can make it difficult to remember things, concentrate, or think clearly. Many with fibromyalgia report that brain fog is worse than fibromyalgia’s hallmark symptom – pain.1
Fibromyalgia is classified as a chronic pain syndrome that affects your musculoskeletal system, as evidenced by the presence of widespread muscle pain, tenderness, and stiffness. So, how does fibromyalgia affect the brain, resulting in cognitive impairment?
Ahead, we’ll answer that question and learn more about fibromyalgia’s effects on the brain, and ways to manage brain fog.
Why Does Fibromyalgia Cause Brain Fog?
Like other fibromyalgia symptoms, the severity of brain fog differs from day to day and from person to person. Factors such as stress, sensory overload, fatigue, or anxiety can also worsen brain fog.
A 2018 study showed that those with fibromyalgia performed more poorly on neuropsychological tests compared to those without fibromyalgia, specifically in the areas of:1
- Attention
- Verbal memory
- Cognitive flexibility
- Mental planning
- Organization skills
- Processing speed
So while fibromyalgia has a significant impact on your musculoskeletal system, it also greatly impacts your CNS.
How Fibromyalgia Affects the Central Nervous System
The brain, along with your spinal cord, make up your central nervous system (CNS). The CNS is vital for regulating pain, mood, cognitive function, and sleep. More specifically, the brain handles many executive functions, such as:
- Memory
- Planning
- Attention or concentration
- Problem-solving
- Emotional regulations
- Decision making
So what causes these changes? Recent research may have some answers.
Normal brain vs. “fibromyalgia brain”
Studies show that patients with fibromyalgia have an imbalance in specific neurotransmitters in their CNS.2 Neurotransmitters are chemical messengers that deliver messages from your brain to your cells and vice versa.
In a normal brain, neurotransmitters like serotonin, dopamine, glutamate, and norepinephrine are carefully balanced to regulate mood, sleep, and pain perception.2 But, in those with fibromyalgia, these neurotransmitters are often imbalanced. For instance, glutamate is an excitatory neurotransmitter, meaning it stimulates or turns your nerve cells on. And those with fibromyalgia have higher levels of glutamate in pain processing areas.2 Experts believe the imbalance in neurotransmitters contributes to heightened pain sensitivity, fatigue, and mood disturbances seen in those with fibromyalgia.2
Fibromyalgia also affects the CNS through changes in the structure and function of the brain. Neuroimaging studies show those with fibromyalgia have higher activity in the brain’s pain-processing regions compared to individuals without fibromyalgia when exposed to the same stimuli.2
Researchers have also found heightened activity in brain regions responsible for sensory and emotional aspects of pain processing.2 This means that not only do those with fibromyalgia perceive pain more intensely, but they also may experience it more on an emotional level too.2
Individuals with fibromyalgia also appear to have a decrease in brain connectivity between regions that help reduce pain sensations. These changes are what many experts believe contribute to the heightened pain response and sensory sensitivity experienced by individuals with fibromyalgia.2
Centralized Pain and Brain Fog
Centralized pain is when your CNS is in a constant state of overactivity. With centralized pain, your brain interprets pain signals throughout your body as more intense than they actually are, even from non-painful stimuli.
Centralized pain differs from pain localized to a specific area of your body. For instance, a broken bone causes sudden, sharp pain in the area where the break occurred. In contrast, those with fibromyalgia have pain that affects the muscles, joints, and even deep tissues throughout the body. Centralized pain is often described as a dull, achy pain that lingers throughout the day. Having centralized pain also means that pain affects both sides of your body rather than just one part, quadrant, or side.
Some suspect this constant influx of pain signals can overwhelm your CNS, resulting in cognitive difficulties in your memory and thinking. Additionally, persistent pain signals can lead to sleep disturbances, another common symptom of fibromyalgia. Poor sleep can lead to sleep deprivation, causing extreme fatigue further exacerbating cognitive dysfunction.
Treatment for Fibromyalgia Brain Fog
The driving force behind fibromyalgia brain fog is the severity of one’s pain.3 A higher pain score puts one at a greater risk for cognitive impairment. Because of this, many fibromyalgia brain fog treatments focus on managing pain.
If you are experiencing brain fog as part of your fibromyalgia symptoms, there are several treatment options. Keep in mind that there is no one-size-fits-all when it comes to fibromyalgia brain fog treatment. More than likely, you may need to talk with your doctor and try a couple before finding which one works best for you.
Before starting treatment, your provider may recommend cognitive testing. Cognitive testing helps to identify problems and determine your level of brain fog or cognitive impairment. Having a cognitive baseline before starting therapy makes it easier for your provider to tell if treatments are working.
Medications for Brain Fog
Several medications and supplements may help in managing fibromyalgia brain fog. Many of these medications that help manage symptoms of fibromyalgia work by increasing serotonin and norepinephrine levels in your body.2 This action helps restore their balance, resulting in pain reduction as well as improvements in sleep and fatigue, another very intrusive symptom of fibromyalgia.
By effectively managing pain and sleep troubles, many individuals see an improvement in their fatigue and cognitive function. Medications for fibromyalgia brain fog commonly include:
- Duloxetine (Cymbalta)
- Milnacipran (Savella)
- Pregabalin (Lyrica)
- Amitriptyline (Elavil)
It is important to know that the first three medications listed above are FDA-approved for treating fibromyalgia. Amitriptyline is not FDA-approved; however, there is evidence that it is effective in managing fibromyalgia symptoms.4 Your provider may also recommend other medications to address specific symptoms, such as an antidepressant to manage anxiety or depression or a sleep aid like Ambien or Lunesta to help with sleep disturbances.
Limited evidence suggests certain fibromyalgia supplements for brain fog may provide extra benefit in managing symptoms. Omega-3 fatty acids, commonly found in fish oil supplements, may help reduce brain fog and improve cognitive function.5 Another supplement that may be beneficial is L-acetyl-carnitine, which plays a role in energy production and can improve pain.6 And pain improvement indirectly has a positive effect on mental clarity and focus.
You may have heard about other supplements that can improve fibromyalgia brain function or brain fog. In general, evidence for supplements tends to be limited, but this doesn’t mean there isn’t a place for them in therapy. Just be sure to check with your provider before starting one to make sure it is safe for you.
Behavioral Treatments for Brain Fog
Physical and emotional stress can worsen fibromyalgia symptoms, including brain fog. Learning how to manage stressful events can help improve symptoms and well-being.
One way to do this is through a type of behavioral therapy known as cognitive behavioral therapy (CBT). CBT helps identify and reframe negative thoughts and feelings about fibromyalgia symptoms. It also teaches coping strategies for managing stress and fatigue.
There are different types of CBT sessions. Some focus on a specific symptom, such as sleep or stress. A recent study showed that those receiving CBT for insomnia had significant improvement in their sleep.7 Researchers believe this improvement in sleep is what led to a greater decrease in pain seen six months later compared to the CBT for pain or control groups.7 By addressing underlying pain and stress through CBT, many see improvement in brain fog.
Another type of CBT widely used in those with fibromyalgia is acceptance and commitment therapy (ACT). ACT aims to help individuals break free from the struggle with their symptoms while giving them coping strategies to manage their adaptive behaviors and emotions.8 A 2023 study showed that 73% of those using an ACT smartphone-based mobile app called Stanza saw improvement in their fibromyalgia symptoms and overall well-being.9
Recent studies show that mindfulness practices can reduce stress and improve cognitive function and sleep disturbances.10 Mindfulness practices such as meditation or yoga encourage you to focus on the present moment. These practices involve calming your mind and letting go of distracting thoughts and worries.
Physical Treatments for Brain Fog
Physical therapies focus on movements to help strengthen or improve how your body functions—these types of therapy range from physical touch to self-guided movement.
An effective way – some may argue the most effective way – to improve your cognitive function is to take part in regular movement. Even light activity, such as walking or aquatic aerobics, can help. As a result, you may see an improvement in cognitive function.
Movement may change the levels of neurotransmitters in your brain, further helping to improve brain fog.2 Animal studies showed that activity had a positive effect on serotonin levels in subjects with nerve pain.2 As a result, researchers saw an improvement in CNS function and widespread pain. Furthermore, movement may also decrease glutamate levels in brain processing areas.2
Another way to increase serotonin levels in your body is through massage therapy.11 A review of the literature showed massage therapy significantly reduces pain, anxiety, and depression.11 But in the study, to see these benefits, participants had to receive massage therapy for five weeks or more.
Transcutaneous electric nerve stimulation (TENS) is a type of physical treatment usually performed by a physical therapist. It sends a low-voltage electric current at or near your nerves to help relieve pain. Experts believe this helps activate central pathways in your brain that block pain.2
Other physical treatments that have evidence supporting their use in those with fibromyalgia include:
- Red light therapy
- Myofascial release
- Cupping
- Acupuncture
Where to Find Help for Fibromyalgia Brain Fog
Fibromyalgia Specialists
Many providers can help you manage your fibromyalgia symptoms. Some of these providers include your primary care doctor, a rheumatologist, or a pain specialist. But did you know there are fibromyalgia specialists that you can work with to treat your symptoms?
Swing Care provides comprehensive, personalized care to those with fibromyalgia. Our treatments are evidence-based and include traditional medications as well as holistic approaches. Suppose you choose to partner with a Swing Care provider: The doctor would meet with you to review your symptoms and medical history and rule out other potential medical conditions that could be causing your symptoms. They’d then walk through your goals with you to determine what treatments might be most effective for your unique symptoms.
Whether you work with a Swing Care provider or not, be sure to work closely with your provider. Being consistent with your prescribed treatments is essential to finding the most effective approach for managing fibromyalgia brain fog.
Take a Self-Assessment
A fibromyalgia diagnosis relies on the results obtained from a series of questionnaires, including the Widespread Pain Index and the Symptom Severity Score. These assessments help gauge the likelihood that fibromyalgia is the cause of your current symptoms.
There are some fibromyalgia self-assessments available online, which you can complete from the comfort of your home. It is important to note that results from self-assessments can’t provide an official diagnosis – only a healthcare provider can. You can use the results from your self-assessment to guide your discussion with a provider.
Medically reviewed by Dr. Andrea Chadwick, MD
References
- 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: https://doi.org/10.3389/fpsyg.2018.00377
- Sluka KA, Clauw DJ. Neurobiology of fibromyalgia and chronic widespread pain. Neuroscience. 2016 Dec 3;338:114-129. doi: https://doi.org/10.1016/j.neuroscience.2016.06.006
- Galvez-Sánchez CM, Duschek S, Reyes Del Paso GA. Psychological impact of fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019 Feb 13;12:117-127. doi: https://doi.org/10.2147/PRBM.S178240
- Lawson K. A Brief Review of the Pharmacology of Amitriptyline and Clinical Outcomes in Treating Fibromyalgia. Biomedicines. 2017 May 17;5(2):24. doi: https://doi.org/10.3390/biomedicines5020024
- Dighriri IM, Alsubaie AM, Hakami FM, Hamithi DM, Alshekh MM, Khobrani FA, et al. Effects of Omega-3 Polyunsaturated Fatty Acids on Brain Functions: A Systematic Review. Cureus. 2022 Oct 9;14(10):e30091. doi: https://doi.org/10.7759/cureus.30091
- Rossini M, Di Munno O, Valentini G, Bianchi G, Biasi G, Cacace E, et al. Double-blind, multicenter trial comparing acetyl l-carnitine with placebo in the treatment of fibromyalgia patients. Clin Exp Rheumatol. 2007 Mar-Apr;25(2):182-8
- McCrae CS, Williams J, Roditi D, Anderson R, Mundt JM, Miller MB, et al. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial. Sleep. 2019 Mar 1;42(3):zsy234. doi: https://doi.org/10.1093/sleep/zsy234
- Dindo L, Van Liew JR, Arch JJ. Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics. 2017;14(3):546-553. doi: https://doi.org/10.1007/s13311-017-0521-3
- Catella, S., Gendreau, R.M., Kraus, A.C. et al. Self-guided digital acceptance and commitment therapy for fibromyalgia management: results of a randomized, active-controlled, phase II pilot clinical trial. J Behav Med (2023). doi:https://doi.org/10.1007/s10865-023-00429-3
- Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull. 2021 Jun 10;138(1):41-57. doi: https://doi.org/10.1093/bmb/ldab005
- Li YH, Wang FY, Feng CQ, Yang XF, Sun YH. Massage therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014 Feb 20;9(2):e89304. doi:https://doi.org/10.1371/journal.pone.0089304
