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Fibromyalgia and attention deficit hyperactivity disorder

Laurence Leaver, Allyson Parry and Helen Read
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DOI: https://doi.org/10.7861/clinmed.Let.23.1.3
Clin Med January 2023
Laurence Leaver
Jericho Health Centre, Oxford, UK and fellow, Green Templeton College, Oxford University, Oxford, UK
Roles: General practitioner
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Allyson Parry
Oxford University Hospitals, Oxford, UK
Roles: Consultant neurologist
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Helen Read
London, UK
Roles: Consultant psychiatrist
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Editor – We appreciate the RCP concise guideline on fibromyalgia (FMS),1 but are disappointed attention deficit hyperactivity disorder (ADHD) is not mentioned. Anxiety and depression are mentioned but these may be merely symptoms secondary to underlying disorders (eg post-traumatic stress disorder, ADHD, autism), and we risk oversimplifying the psychological part of the biopsychosocial model. Several studies show that ADHD (either formally diagnosed or implied by positive screening tests) is prevalent in patients with FMS: 44.7% in a South African study,2 24.5% in an Italian study,3 32.3% in a Spanish study,4 25% in a study undertaken in the Netherlands,5 and 29.5% in a Turkish study.6 Symptoms of ADHD correlate with severity of FMS.7 Bou Khalil et al8 suggest how the psychopathology of ADHD may predispose to FMS. Patients with suspected but unconfirmed FMS may be likely to have similar rates of ADHD.

As early as 1998, Krause et al9 noticed that some patients with ADHD had FMS and that treatment with stimulants could help both conditions. Despite the absence of randomised controlled trial evidence, it remains likely that treating comorbid ADHD improves quality of life, if not FMS directly. It is interesting to note10 that methylphenidate improves tolerability of pain in ADHD (without FMS). The RCP guidelines are aimed at generalists, who are responsible for referring to mental health services: it would be important not to miss a common treatable comorbidity. FMS may also be associated with prior PTSD11 and autism,12 which may benefit also from specific interventions.

Physicians, and commissioners, may note that ADHD is common in other ‘physical’ conditions,13 particularly chronic fatigue syndrome, and hypermobility spectrum disorders, which are also associated with FMS. Further, physicians may be interested to know that ADHD is associated with autonomic dysfunction such as postural orthostatic tachycardia syndrome (POTS), functional bowel disorders, functional urinary disorders such as enuresis, migraine, and other conditions.

Competing interests

Drs Leaver & Parry are affiliated with the UK Adult ADHD Network (UKAAN).

  • © Royal College of Physicians 2023. All rights reserved.

References

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    1. Berwick R
    , Barker C, Goebel A; guideline development group. The diagnosis of fibromyalgia syndrome. Clin Med 2022;22:570–4.
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    1. van Rensburg R
    , Meyer HP, Hitchcock SA, Schuler CE. Screening for adult ADHD in patients with fibromyalgia syndrome. Pain Med 2018;19:1825–31.
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    , Porta F, Salerno L. Adult attention deficit hyperactivity disorder in patients with fibromyalgia syndrome: Assessment and disabilities. J Psychiatr Res 2021;136:537–42.
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    , Ponce G, Rodriguez-Jimenez R, et al. High frequency of childhood ADHD history in women with fibromyalgia. Eur Psychiatry 2011;26:482–3.
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    , Tamam L. Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia. Neuropsychiatr Dis Treat 2018;14:1883–9.
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    1. Türkoğlu G
    . Attention-deficit hyperactivity disorder symptoms and quality of life in female patients with fibromyalgia. Turk J Med Sci 2021;51:1747–55.
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    1. Bou Khalil R
    , Khoury E, Richa S. The comorbidity of fibromyalgia syndrome and attention deficit and hyperactivity disorder from a pathogenic perspective. Pain Med 2018;19:1705–9.
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    1. Krause K-H
    , Krause J, Magyarosy I, et al. Fibromyalgia syndrome and attention deficit hyperactivity disorder: is there a comorbidity and are there consequences for the therapy of fibromyalgia syndrome? J Musculoskelet Pain 1998;6:111–6.
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    1. Treister R
    , Eisenberg E, Demeter N, Pud D. Alterations in pain response are partially reversed by methylphenidate (Ritalin) in adults with attention deficit hyperactivity disorder (ADHD). Pain Pract 2015;15:4–11.
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    1. Häuser W
    , Galek A, Erbslöh-Möller B, et al. Posttraumatic stress disorder in fibromyalgia syndrome: prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain 2013;154:1216–23.
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    , Chiba Y, Kato I, Tani Y, Yamanaka H. Neurodevelopmental disorders associated with juvenile fibromyalgia. Pediatr Int 2018;60:1034–5.
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    1. Instanes JT
    , Klungsøyr K, Halmøy A, Fasmer OB, Haavik J. Adult ADHD and comorbid somatic disease: a systematic literature review. J Atten Disord 2018;22:203–28.
    OpenUrlCrossRefPubMed
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Fibromyalgia and attention deficit hyperactivity disorder
Laurence Leaver, Allyson Parry, Helen Read
Clinical Medicine Jan 2023, 23 (1) 100; DOI: 10.7861/clinmed.Let.23.1.3

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Fibromyalgia and attention deficit hyperactivity disorder
Laurence Leaver, Allyson Parry, Helen Read
Clinical Medicine Jan 2023, 23 (1) 100; DOI: 10.7861/clinmed.Let.23.1.3
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