Cognitive problems within fibromyalgia patients are a common occurrence although not well understood. Commonly and not so fondly described as ‘fibro fog’, these cognitive issues are akin to thinking through a fog, making it hard to understand your surroundings, to figure out what you want to say and to be able to concentrate. These cognitive issues have been reported in between 50% to 80% of patients with fibromyalgia as shown by this study.
What can fibro fog effect?
Let’s take a look at what this cognitive dysfunction typically effects in patients, although these aspects of fibro fog can be experienced to differing degrees by patients:
Fibro fog can affect your short term and long-term memory. This study shows that “fibromyalgia patients have impairments in working, episodic, and semantic memory that mimic about 20 years of aging” and also states that when tasks are more complicated or patients are trying to focus on more than one thing at once, these memory problems are at their most amplified.
These memory problems can make it hard to remember many things; you can forget things as simple as what you were talking about, where you put something, whether you turned something off or even what you were supposed to be doing. This can be very detrimental if you are trying to work or to perform a particular task, as well as making daily life more difficult.
This ‘fog’ can make it very difficult to focus on things in your environment, to be able to understand your surroundings and can affect all of your senses at once. This problem with concentration can make it very difficult to maintain your level of functioning.
- Information processing
This cognitive dysfunction can make it very hard to understand what someone else is trying to say or to take in information, whether that be something you are reading, trying to learn or just day to day tasks you are trying to perform.
- Ability to engage in conversation
When it’s tough to focus on what someone else is saying that can make it difficult to engage in a conversation; when you combine that with finding it difficult to speak and to find the words you want to say, it can make maintaining a conversation near impossible. This can be seen from an outside perspective as slowed or delayed speech, confusion during a conversation, and the patient not being able to voice what they are trying to say. This study showed that,
FM patients had lower scores on vocabulary tests, and had lower scores on a verbal fluency test
Having your senses impacted, not being able to focus on things in your environment or process what is happening around you, can all be very disorientating and confusing.
- Decision making
These cognitive processing problems can make it extremely difficult to make decisions, whether smaller things about what to do in your day to day life, or bigger life choices, especially when you are aware that you might not be able to rely on your mind. This study found that patients with fibromyalgia had a harder time making accurate and effective choices.
What causes fibro fog?
The exact cause of the cognitive problems that come with fibromyalgia is not known, but what is known, is that fibro fog is a symptom in its own right. It has been theorised that these cognitive issues could be a result of the problems with sleep that come with fibromyalgia along with the fatigue and depression that are often present. This is not an unreasonable assumption, but these potential causes, while they can compound the cognitive issues, are not the actual cause. In fact, it’s been found that it’s the pain that fibromyalgia patients are experiencing that actually causes these cognitive problems, as shown by this study.
Pain itself interrupts cognitive functioning; many of the same areas that control and process pain are also used to perform cognitive tasks, and the brain only has so many resources. While the brains of fibromyalgia patients are so overtaken by the pain that they are experiencing, it can be hard for their brain to give these cognitive processes the attention that they need. This study explains that, “It has been suggested that dyscognition may derive from the brain resources competition between pain processing and cognitive performances” .
Blood flow within the brain has also been shown to affect cognitive tasks and correlates with cerebral blood flow associated with pain, again indicating that the two come from similar causes and can affect each other. This study concludes that “Cognitive impairment in FMS is associated with alterations in cerebral blood flow responses during cognitive processing”
The cause of these cognitive problems fundamentally seems to be related to pain and is then made significantly worse by symptoms of mental illness such as the depression and anxiety that come with fibromyalgia. It seems that the more pain a patient is experiencing, the greater their difficulties with fibro fog. This study is one of many which concludes that, “cognitive performance is primarily affected by pain”. Other studies which provide similar conclusions can be found here and here.
How does fibro fog really feel?
Now that we have a grasp of what fibro fog effects and the science behind it, let’s look at the more human aspect; how fibro fog really feels. I have been living with fibromyalgia for around six years now, possibly longer looking back on earlier life; the previous five to six years have been when my symptoms really became significant and life altering.
Fibro fog can be one of the most debilitating symptoms and was for me for a long while; previously it would limit my functioning and be highly detrimental to my life. Now that my symptoms and pain are more under control and my level of functioning has increased, I have found that it only affects me when my symptoms are really flaring, when I have done a lot of exercise or at the end of a long day when I’ve been very busy.
It certainly does seem to me that as my pain increases, so does the fibro fog become increasingly present and harder to contend with, which ties in with the research we discussed. While my fibro fog can be highly distressing, it now starting later in the day really allows me to maintain a higher level of functioning which is not something I take for granted.
When fibro fog makes its appearance, it really does feel like thinking through a fog, like there is a veil over everything, making it hard to see, to understand my surroundings and think with any sense of clarity. I struggle to understand what my husband is saying, what I am trying to read or write, to remember what I want to say or what the task at hand was.
I describe it in two ways to help my loved ones to understand what I am going through more. That feeling when you walk into a room on autopilot but can not for the life of you remember why you are there or what you were going to do, or that feeling when you know the phrase you want and it’s on the tip of your tongue, but you can’t quite access it: it’s similar to those sort of feelings but amplified and constant while the fibro fog is present. It affects everything during that period. It can be incredibly frustrating when you are trying to function and lose your train of thought or can’t complete a task; it can also be scary when you struggle to comprehend the world around you.
Tips for dealing with fibro fog
While fibro fog is certainly daunting, there are ways that you learn to live with it and around it, to improve your symptoms and to take its power away. Some of the ways I’ve found from my own experience to tackle fibro fog are included below:
- CBT (Cognitive Behaviour Therapy)
Treating the pain and reducing other symptoms of fibromyalgia with CBT or other mindfulness techniques, therefore deals with the cause of fibro fog and can reduce its impact.
I do feel that a lot of the work I put in to gradually increase my functioning, increasing gentle exercise and learning how to retrain my brain to take a more positive approach, has really helped to reduce my fibro fog along with other symptoms. These approaches have also allowed me not to fear fibro fog, understanding it’s cause and that it’s only temporary and is going to pass. This gives me a sense of security and comfort.
- Being open with those around you
Often when you’re struggling with fibro fog you can feel a lot of pressure not to let others see what you’re going through, trying desperately to keep up with conversations, and in turn this can make you isolate yourself because you may be embarrassed or feel that you can’t participate in social situations.
Being open with those in your life and explaining what you are going through, asking them to bear with you and to understand, can take that pressure away. This openness can allow those around you to be aware that you might react a little differently. I let my husband know when my fibro fog is at its worst, so that he can be aware that I may need extra reminders and extra patience.
- Making lists and notes
Writing down reminders, whether on your phone, on a piece of paper or on sticky notes around the house, can really set you up for success and help to prompt you to remember things that fibro fog may cause you to forget. This can be things ranging from where you can find things, what you need to buy from the shop, or what tasks you have to do that day.
Whatever works for you and your routine is what is most important, to make things as easy for yourself as you can. I tend to make lists for everything: goals for the day, ideas for writing, shopping lists, the plan for the day among others, and I really do find that it helps me.
- Setting alarms
If you have specific times that you need to do things during the day, for example taking medication or leaving the house for an appointment or work, then setting alarms on your phone can help to keep you on track.
I use alarms to remind me of my medication which I take at the same time every day, and also as a vital tool when I’m cooking to remind me to turn off the oven and when the food is going to be ready, as well as when I have appointments. This allows me to maintain that functioning and independence even when my fibro fog is at its most prevalent.
- Monitoring your fibro fog
Keeping a note of patterns that you might see in your memory issues, things that you typically forget on a more regular basis or mistakes you make more than once, can allow you to be more prepared for the next time. You can adjust the notes we mentioned to suit these patterns.
Monitoring when your fibro fog tends to be present can also be helpful in being prepared, allowing you to have your lists ready and being able to optimize times when fibro fog is less likely to be present. Preparation gives you the upper hand and allows you to help your future self to succeed.
- Be consistent
Being organized in regards to where you store things in your living space can really help you to remember where things are, even when you’re struggling, for example putting your keys and phone in the same place every time. This can reduce the likelihood that you are going to forget where you put something.
I keep small organisational tubs near me that hold the things that I use every day, which is especially helpful as I work from home, so that I can just reach for the appropriate tub and know that I will find what I need.
- Focus on one thing at a time
Multitasking has been proven to be difficult for patients who are experiencing fibro fog as shown in this study. Therefore setting your priorities and focusing on one task at a time, so that you can really give that task your full focus, is the best way to optimize your brain power.
- Trying to maintain a good sleep pattern
It can be tough to maintain a good sleep routine when you have fibromyalgia but doing all you can to try and get the sleep you need, can reduce fatigue and help your brain function in a more productive way.
I find things like going to bed at the same time each night and waking up around the same time each morning to be helpful to my body clock, as well as winding down for the night in a gradual way to get my mind ready for sleep.
Gentle exercise can help to reduce symptoms of fibromyalgia and in turn can help you sleep. Exercise also releases hormones that help to lift your mood, and improves blood flow, all of which can contribute to your brain functioning in a healthier way.
I started a journey of walking with my dogs over time; that exercise and being out in nature is something that has helped my fibromyalgia vastly, as well as helping my mental health.
- Healthy eating
Giving your body the right fuel to function at its best, is something you can actively do to give your body and mind the best chance possible to function in the way that they should. While it may not take away symptoms, a healthy diet can certainly be helpful in reducing them.
When living with a chronic illness it can be tough to keep up with healthy eating; something that I’ve found very helpful is food preparation, preparing healthy meals in advance that can just be quickly heated up later, to aid in maintaining healthy eating habits.
- Stress reduction
Looking at ways that you can actively reduce stress in your life can aid in improving your symptoms, likely lowering your pain and therefore your fibro fog.
Things like ensuring you are taking breaks if you are working, not trying to deal with too many things at once, talking about problems with loved ones and practicing self-care are some of the many ways that you lower your stress levels.
One of the things that really helps both myself and my husband to deal with my fibro fog is humour. We laugh at words I forget and giggle when I say the wrong word for things; making a joke out of it helps me to cope, to see the lighter side of it and to feel less intimidated by it. Finding humour in hard times is a way of coping that comes naturally to me and is something that I have found invaluable.
As emotionally draining as the cognitive symptoms that come with fibromyalgia can be, there are ways that you can work around them and reduce their effect on your life. You can take that power back and learn to live a happy and productive life even with fibro fog rearing its ugly head; the more weapons in your arsenal in your fight against your chronic illness, the more power you have and the less your illness has.
- The Journal of Clinical Psychiatry, Glass JM, (2008), “Fibromyalgia and cognition.”
- Frontiers in Psychology, Carmen M. Galvez-Sánchez, Gustavo A. Reyes del Paso,Stefan Duschek, (2018), “Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem”
- Munguía-Izquierdo, Legaz-Arrese A, Moliner-Urdiales D, Reverter-Masía J., (2008), “Neuropsychological performance in patients with fibromyalgia syndrome: relation to pain and anxiety”
- Duschek S, Werner NS, Winkelmann A, Wankner S., (2013), “Implicit memory function in fibromyalgia syndrome.”