Fibromyalgia and cognitive disorders: everything there is to know!

What is fibromyalgia?

Fibromyalgia is a chronic condition characterised by persistent diffuse pain (muscle and/or joint pain) and sensitivity to pressure. This pain is generally associated with intense fatigue, sleeping disorders, depressive symptoms and anxiety-related disorders (depression and anxiety are 4 times more frequent than in the general population).

In some cases, patients also complain of headaches, stomach aches, jaw pain, constant urination, painful periods, or tingling in the fingers or feet.

Patients experience pain in the whole body, without interruption, for several months. Normally painless stimuli can cause pain, while pain that is normally bearable can be perceived as intense by fibromyalgia patients.

These symptoms lead to worsening of the patients' quality of life.

In over 80% of cases, fibromyalgia affects women aged between 30 and 55. It frequently appears around the time of the menopause.

In the UK, more than 2.5 million people suffer with fibromyalgia.

What are the cognitive symptoms related to fibromyalgia?

Fibromyalgia is one of the main causes of chronic diffuse pain. Pain is the hallmark of this condition, but there is a complex variety of symptoms that develop apart from it. Fibromyalgia patients often complain of certain cognitive problems.

Cognitive impairment is often viewed by fibromyalgia patients as even more disabling than pain. Some major cognitive disorders include short- and long-term memory problems, reduced attention span and concentration, difficulty finding the right words, etc. Such symptoms are commonly known as "fibro-fog".

Meta-analysis of the research data was presented in the journal Psychosomatic Medicine. Researchers reviewed major medical databases and analysed the studies published on the subject before September 2017. They selected 23 case-control studies involving a total of 2,096 participants and carried out a meta-analysis. All these studies used neuropsychological tests and reference scales to assess the cognitive performance of fibromyalgia patients and healthy control groups.

This meta-analysis showed that:

• Cognitive function is significantly lower (-13%) in patients with fibromyalgia compared to healthy people,
  

• The effects of cognitive decline are mainly on learning, memory, attention and psychomotor speed,
  

• A more moderate effect of the disease was noted on executive function and working memory,
  

• There was a link between patients' age, the number of years since diagnosis and levels of cognitive dysfunction,
  

• Higher depression and anxiety rates were reported when cognitive impairment was more severe.
  

However, according to the studies that have looked for a link between the severity of pain and the degree of cognitive dysfunction, no correlation has been identified. This means that attention, memory and information processing are not necessarily correlated with pain levels.

What can be done with cognitive disorders related to fibromyalgia? 

Cognitive disorders result from a decline in one or more cognitive functions, with more or less severe repercussions on a number of daily activities.

In some neuromuscular diseases, specific cognitive problems are often the consequence of the disease itself and/or can be linked to the patient's living and care conditions (fatigue, stress, anxiety, etc.).

The management of cognitive disorders therefore consists of re-educating cognitive functions that have become fragile, maintaining those that are operational in order to compensate for those that are declining, and implementing strategies to overcome the existing difficulties in order to "learn to do things differently".

Cognitive remediation is the term used to describe this specific form of care. It involves learning how to manage the impact of cognitive problems on patients' daily lives. Its aim is not to cure, but to enable patients suffering from fibromyalgia to function optimally and improve their quality of life.

This is a long-term process that often requires the involvement of a multidisciplinary team: a neuropsychologist, a speech therapist, an occupational therapist and sometimes a psychomotor therapist. Each of these healthcare professionals focuses on different aspects of cognition.

It takes several months, if not years, of work to see cognitive abilities improve. Cognitive remediation involves regular sessions, regular attendance and daily training at home. It is only effective if it is done properly.