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It’s like wearing one ear plug, floppy shoes, and a parka while swimming through a muddy ditch. And then falling asleep and waking up with no idea where you are, who you are, and what somebody just said — you see mouths moving, but it’s gibberish. Then it all trickles back to reality slowly. You feel hungover, and typically hurt everywhere.

That’s what fibro fog feels like to CreakyJoints member Kathy M. Another describes it as being under water — where your senses are dulled and movement is slow and clumsy.

Fibro fog, or brain fog, is symptom of fibromyalgia that you may not expect. But it is one that can be just as problematic as the pain that’s characteristic of the condition. “Fibro fog is something we hear about quite a bit,” says Christopher Morris, MD, a rheumatologist with Arthritis Associates of Kingsport, in Tennessee. Patients will say they seem more forgetful or feel like they’re walking around in a daze all the time.

What Exactly Is Fibro Fog?

Fibromyalgia causes aches and pains all over the body, as well as fatigue, sleep, and mood issues. It can also lead to problems with memory or thinking clearly. These cognitive difficulties — called fibro fog — are common: Research suggests more than half of people with fibromyalgia show a decline in memory and clear thinking.

When you have fibro fog, it can cause you to be in a state of confusion that you don’t even know you’re in, CreakyJoints member Joan W. shared on Facebook. You can’t find the words you want to say or you misspeak without realizing it. You may also experience:

  • Memory issues or forgetfulness
  • Impaired ability to concentrate or stay focused
  • Decreased alertness
  • Problems thinking clearly or mental slowness
  • Difficulty holding a conversation

Some research has also shown deficits in what’s known as executive functioning skills, such as planning abilities, decision making, and abstract thinking.

The impact of fibro fog on everyday life is significant. In fact, patients with fibromyalgia often report that these cognitive symptoms are more disabling than their pain. It makes you feel like you’re losing your mind, CreakyJoints member Sharon C. shared on Facebook.

What Causes Fibro Fog?

Scientists don’t know for sure. Some experts theorize that fibro fog may be related to the impact of fibromyalgia pain. Managing chronic pain demands attention and may some take mental effort, which can reduce available cognitive processing resources and affect performance on a cognitive task.

Also, fibromyalgia in and of itself is a neurologic health problem, adds Dr. Morris. There is a dysregulation of how certain neurologic pathways and neurotransmitters function within the brain, which may also play a role in cognitive issues. “All of the things that are interacting in some of the same pathways that are causing the pain might be having the same effect on thought processes,” he explains.

Fibro fog may also be associated with other aspects of fibromyalgia, such as poor sleep. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea. Sleep deprivation can cause processing problems, adds Dr. Morris.

Depression, which is common among people with fibro, may be another factor. One study published in the journal PLOS One suggests many of the cognitive issues experienced by patients with fibromyalgia can be attributed to depression.

More research is needed as to how and why fibromyalgia is associated with cognitive problems.

How to Treat and Manage Fibro Fog

The cognitive effects of fibromyalgia can be challenging, and — as some CreakyJoints members admit — embarrassing. It’s important to stick to your fibromyalgia treatment plan, which may include medication, therapy, and self-care. There’s no one-size-fits-all approach to managing fibromyalgia, says Dr. Morris. But the goal is the same: help minimize symptoms and improve general health. You and your doctor will determine the best plan for you.

To help cut through the brain fog and thinking more clearly, here are some strategies:

Exercise your body

This is the best treatment for fibromyalgia, says Dr. Morris. Research from Sweden showed that physical exercise over a long term improves cognitive processing, as well as overall symptoms of fibromyalgia. Start slowly and with light stretching, then gradually increase activity. Some good exercises include walking, swimming, and water aerobics. Your doctor or physical therapist can recommend workout that are safe and appropriate for you.

Work out your brain

Brainteasers, puzzles, playing games like trivia and checkers, and other mentally stimulating activities may also help keep your mind sharp. “You have to exercise the brain the same way as you exercise the body,” says Dr. Morris.

Stick to a sleep schedule

That means hit the sack at the same time every night and wake up at the same time every morning — even on weekends. This helps to regulate your body’s clock so you fall asleep faster, and rest more soundly. Getting enough sleep lets your body repair itself, physically and mentally. “With fibromyalgia, quality is just as important and quantity,” adds Dr. Morris.

Other tips to help improve sleep: Skip naps, especially in the afternoon; limit caffeine, which can disrupt sleep; and avoid electronics before bed.

Find ways to help you focus

Break up tasks into small steps, so you’re not trying to do too much at once. And when you do start a task, avoid distractions (like a loud TV) so you can give it your full attention. This is also part of energy pacing, another important technique for managing fatigue in fibro.

Make time to relax each day

Deep-breathing exercises and meditation can help reduce the stress that can bring on symptoms, according to the American College of Rheumatology.

Use Our ArthritisPower App to Manage Your Fibromyalgia

Join CreakyJoints’ patient-centered research registry and track symptoms like fatigue and pain. Learn more and sign up here.

Keep Reading

Bartkowska W, et al. Cognitive functions, emotions and personality in woman with fibromyalgia. Journal of Biological and Clinical Anthropology. December 2018. doi: http://dx.doi.org/10.1127/anthranz/2018/0900.

Bertolucci PHF, et al. Cognitive Impairment in Fibromyalgia. Current Pain and Headache Reports. July 2013. doi: http://dx.doi.org/10.1007/s11916-013-0344-9.

Cognitive Function & Fibromyalgia. National Fibromyalgia Association. http://www.fmaware.org/articles/cognitive-function-fibromyalgia.

Etnier JL, et al. Exercise, Fibromyalgia, and Fibrofog: Journal of Physical Activity and Health. A Pilot Study. March 2009. doi: https://doi.org/10.1123/jpah.6.2.239.

Fibromyalgia. American College of Rheumatology. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia.

Fibromyalgia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780.

Fibromyalgia: Managing Fibro Fog. Michigan Medicine. https://www.uofmhealth.org/health-library/zt1337.

Gelonch O, et al. The effect of depressive symptoms on cognition in patients with fibromyalgia. PLoS One. July 2018. doi: https://doi.org/10.1371/journal.pone.0200057.

Galvez-Sanchez CM, et al. Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem. Frontiers in Psychology. March 2018. doi: https://doi.org/10.3389/fpsyg.2018.00377.

Healthy Sleep Tips. National Sleep Foundation. https://www.sleepfoundation.org/articles/healthy-sleep-tips.

Interview with Christopher Morris, MD, a rheumatologist with Arthritis Associates of Kingsport, in Tennessee

Martinsen S. The Role of Long-Term Physical Exercise on Performance and Brain Activation During the Stroop Colour Word Task in Fibromyalgia Patients. Clinical Physiology and Functional Imaging. May 2018. doi: https://doi.org/10.1111/cpf.12449.

Pidal-Miranda M, et al. Broad cognitive complaints but subtle objective working memory impairment in fibromyalgia patients. Brain and Cognition. November 2018. doi: http://dx.doi.org/10.7717/peerj.5907.