On the Importance of Screening for ADHD in Patients With Fibromyalgia

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The impact of fibromyalgia syndrome was assessed using the Revised Fibromyalgia Impact Questionnaire.
The impact of fibromyalgia syndrome was assessed using the Revised Fibromyalgia Impact Questionnaire.

Adult attention deficit hyperactivity disorder (ADHD) frequently co-occurs with fibromyalgia syndrome (FMS) and may negatively affect FMS-related morbidity, according to results from a cross-sectional, observational study published in Pain Medicine.

Investigators screened a total of 123 patients with FMS using the World Health Organization (WHO) Adult ADHD Self Report scale v1.1 to determine the frequency of ADHD in the setting of FMS. The impact of FMS was assessed using the Revised Fibromyalgia Impact Questionnaire (FIQ-R).

Self-reported cognitive function as well as anxiety and depression were evaluated using the 2010 modified American College of Rheumatology criteria, the FIQ-R, and the 14-item Hospital Anxiety and Depression Scale, respectively.

Almost half of the screened participants (44.72%) tested positive for adult ADHD. Patients who had FMS as well as adult ADHD had higher FIQ-R scores than patients with FMS only (64.74±17.66; P =.001). Study participants with FMS who had not pursued their education beyond high school were more likely to present with adult ADHD than study participants with a college level-education (30.91% vs 13.24%; P =.03). In addition, cognitive impairment was found to be higher in patients with FMS and co-morbid ADHD than in patients with FMS only (odds ratio [OR], 10.61; 95% CI 3.77-29.86; P =.0001).

Study participants with FMS plus ADHD had higher rates of anxiety (90.91% vs 70.59%; OR, 4.17; 95% CI, 1.45-11.99; P =.005) and depression (56.36% vs 35.29%; OR, 2.37; 95% CI, 1.14-4.91; P =.019) compared with patients with FMS only.

A comprehensive clinical assessment for ADHD was not conducted and assessment of the disorder relied primarily on self-reported questionnaires, thus presenting a study limitation. In addition, all patients with FMS were taking medication prior to and during the study, which may have contributed to cognitive dysfunction.

 

The investigators explain that the higher FIQR scores observed in participants with FMS and ADHD “could possibly be attributed to both the impact of dyscognition and the higher frequencies of anxiety and/or depression in patients with unrecognized adult ADHD.”

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Reference

van Rensburg R, Meyer HP, Hitchcock SA, Schuler CE. Screening for adult ADHD in patients with fibromyalgia syndrome. Pain Med [published online November 1, 2017]. doi:10.1093/pm/pnx275

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