Fibro Fog and ME/CFS Brain Fog

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A specific kind of cognitive dysfunction—also called fibro fog or brain fog—is one of the most common complaints of people with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS).

For many people living with these conditions, it can be severe and may even have as big an impact on their lives as pain or fatigue. In fact, some people say fibro fog is more of a disability than their physical symptoms.

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Research on Brain Fog and ME/CFS

While we don't know exactly what causes our foggy brains, researchers are learning more about this effect.

One study suggested that people who have both FMS and ME/CFS had more cognitive impairment than those who have just ME/CFS. However, people with only ME/CFS appeared to have more problems with visual perception. And people with more pain had a harder time remembering what they heard. This finding is backed up by at least one other study. 

Another study found a link between pain inhibition (the brain's ability to tune out pain) and cognitive inhibition (the brain's ability to tune out other things in your environment). Impaired pain inhibition is a known feature of FMS. Impaired cognitive inhibition could mean, for example, that you can't follow a conversation while the TV is on because your brain can't filter out the background noise.

In the same study, researchers noted that higher self-reported pain in ME/CFS appeared to be linked to slower reaction times, which is a common complaint among people with this condition.

One research team explored the connection between cognitive ability and central sensitization—an overly sensitive central nervous system—which is believed to be a key underlying feature of FMS, ME/CFS, and other related conditions.

They found that cognitive impairment appeared to be linked to:

  • Sensitization
  • Impaired pain processing
  • Hyperalgesia (amplified pain)
  • Lower health-related quality of life

Many people living with these conditions complain that they have trouble coming up with words. One study showed that people with FMS had slow word recall and that they also had deficits in other areas of cognitive measurement.

Causes

We don't yet know exactly what causes cognitive dysfunction in these conditions, but we have a lot of theories about possible contributing factors, including:

  • Sleep that isn't restful or restorative
  • Mental distraction due to pain
  • Overexertion in ME/CFS as a consequence of post-exertional malaise
  • Medications used to treat pain
  • Medications used for treating FMS and ME/CFS
  • Abnormal blood flow to some areas of the brain
  • Abnormal connectivity patterns between different regions of the brain
  • Abnormal function of certain brain chemicals (neurotransmitters)
  • Premature aging of the brain

In FMS, fibro fog generally is worse when pain is worse. In both FMS and ME/CFS, it can be exacerbated when you're especially fatigued, anxious, under pressure, or dealing with sensory overload.

Depression, which is common in FMS and ME/CFS, also is associated with cognitive dysfunction. Some studies, however, show that the severity of brain fog in these conditions is not related to symptoms of depression.

Is There a Link to Learning Disorders?

So far, we don't have evidence that our brain fog comes from known learning disorders. However, our problems are similar to those associated with disorders, such as dyslexia (reading problems), dysphasia (speaking problems), and dyscalculia (math/time/spatial problems).

Symptoms

Symptoms of brain fog can range from mild to severe. They frequently vary from day to day and not everyone has all of them.

Symptoms can include:

  • Word use and recall: Difficulty recalling known words, use of incorrect words, slow recall of names for people and items
  • Short-term working memory problems: Forgetfulness, inability to remember what's read or heard, forgetting what you were doing, losing the train of thought
  • Directional disorientation: Suddenly not recognizing familiar surroundings, easily becoming lost, having trouble remembering how to get somewhere
  • Multitasking difficulties: Inability to pay attention to more than one thing, forgetfulness of original task when distracted
  • Confusion and trouble concentrating: Difficulty processing information, being easily distracted, trouble learning new information
  • Math/number difficulties: Difficulty performing simple math or remembering sequences, transposing numbers, trouble remembering numbers and dates

Some people may also have other types of cognitive dysfunction, too. If you are concerned about your cognitive abilities, talk to your doctor. Proper treatment could help you function better.

You can have cognitive testing to identify your problem, determine your level of dysfunction, and monitor your dysfunction over time to see if interventions are helping.

A diagnosis could also help you get reasonable accommodation at work or strengthen a disability benefits claim if your deficit is severe and untreatable.

Treatments

For some people, brain fog resolves when pain or sleep problems are effectively treated. Managing pain and sleep issues involve a combination of lifestyle modifications and medical therapy.

While we don't have a lot of evidence to support their effectiveness, some doctors and people with these conditions say they've seen supplements help with cognitive function. However, please make sure to consult with your doctor before taking any supplements to make sure it is the right kind for you and to make sure they won’t have interactions with medications you may already be taking.

Supplements that have been considered potentially beneficial for managing brain fog include:

  • 5-HTP
  • B vitamins
  • Carnitine
  • Choline
  • Omega-3 (fish oil)
  • Rhodiola rosea
  • St. John's wort
  • SAM-e
  • Theanine

Some doctors recommend dietary changes to include foods that are natural sources of the supplements listed above.

Some of these foods are:

  • Fish (omega-3)
  • Canola or walnut oil (omega-3)
  • Eggs (choline)
  • Fruits and vegetables
  • Carbohydrates

Some FMS research shows that moderate exercise can help improve cognitive function as well. Exercise is difficult for us, so be sure you know the right way to get started with exercise.

Cognitive Training

Researchers are always learning more about the brain and how it works, and new information could help us understand brain fog. Research on aging brains and some degenerative brain conditions shows that cognitive training can slow, stop, or sometimes even reverse cognitive dysfunction.

Some doctors use cognitive training programs that may include software that you use at home. Video game companies and websites offer games they claim can improve cognitive function, as well.

While specific games haven't been evaluated for this symptom, some evidence does suggest that virtual reality games improve memory and critical thinking skills. Because this is an emerging area of science, we're likely to learn more about cognitive training in the years ahead.

A Word From Verywell

Cognitive dysfunction is tough to live with. It can be frustrating, embarrassing, and difficult to overcome. However, by working with your doctor to find the right mix of treatments, and by finding ways to keep your brain active and compensate for your brain fog, you may be able to undo some of the damage this symptom has done to your life.

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