Fibromyalgia (FMS) and Attention
Deficit Disorder (ADD)
--There is a connection!
GHDavis, MD
1. Characteristics of ADD (Attention
Deficit Disorder):
distractibility
impulsivity
"hyper-something"
(hyper-active, hyper-reactive,
or hyper-sensitive
to
stimuli)
2. Characteristics of FMS
(Fibromyalgia):
chronic fatigue
chronic widespread pain
11 of 18 tender trigger points
3. Symptoms I see in many ADD
patients, common in FMS:
constipation, diarrhea
difficulty with concentration
muscle aches and pains
mood swings
anxiety or worrying
depression, fatigue
variability in symptoms
headaches
hemorrhoids
poor "circulation"
reflux, stomachaches
sleep disturbances
sleep apnea
worse under stress
better with good diet and exercise
defective immune system in many
(autoimmune problems)
can be
mild to severe, so
can cause
no
dysfunction
to severe
dysfunction
No specific abnormalities
show up on
routine
lab
tests or X-rays, but
PET scans show decreased circulation
to frontal lobes.
4. Autonomic Dysfunction Disorder =
the "real ADD" (and FMS)?
Autonomic nervous system (ANS) =
sympathetic
nervous system +
parasympathetic
nervous system +
enteric
nervous system +
endocrine
system
Main neurotransmitters:
norepinephrine,
epinephrine (adrenaline),
and dopamine
5. Other conditions which have
autonomic dysfunction and,
therefore,
similarities to ADD and FMS:
AIDS
Alzheimer’s
chronic fatigue syndrome
irritable bowel syndrome
multiple chemical sensitivity
syndrome
myofascial pain syndrome
multiple sclerosis
Parkinson’s disease
post-traumatic stress syndrome
restless legs syndrome
rheumatoid arthritis
systemic lupus erythematosus
other
autoimmune
disorders
TMJ dysfunction
6. Conditions which improve on
stimulants
or
cortisone:
arthralgias, arthritis, asthma,
respiratory allergies, eczema,
bronchitis,
erythema multiforme, "fine bumps",
(arms), itching, muscle aches,
psoriasis, skin rashes, urticaria
7. Possible mechanism of action with
stimulants:
In
underproducers,
they
may cause adrenal glands to put out
more
cortisol and adrenaline through
direct stimulation.
In
overproducers,
they
may cause adrenals to stop
overproduction of
cortisol and adrenaline, through a
feedback mechanism at the level of
the hypothalamus.
The stimulants also seem to increase
the availability of
Dopamine and Norepinephrine at the
level of the synapses.
8. Stimulants (Ritalin, Concerta,
Adderall, Metadate, Dexedrine, etc.)
for FMS and ADD?
Why might they be used?
relatively inexpensive -- well worth
the expense!
long-term safety profile well
established (despite sensational
reports by nay-sayers)
work better than narcotics,
antidepressants, muscle relaxants,
NSAIDs (remains to be proven)
no side effects at the right dose --
[The RIGHT DOSE = the dose which
produces optimal benefit with NO
side effects.]
Why might they NOT be used?
approved for only ADD and narcolepsy
at this time
controlled drug (class II), along
with narcotics
fear of investigation by state
agents, for doctors who prescribe a
lot of them
concern for drug abuse, but
not
a
problem in people who need them
have to be individually handwritten
and signed by the doctor--no refills
9. Tests that might show the
connection:
(before and after stimulant therapy)
EEG
PET scans
serum cortisol,
neurotransmitters
measures of coordination,
balance, and muscle tension
10. Good ADD resources:
www.add-fibromyalgia.com
www.drjensen.com
www.amenclinic.com
Driven to Distraction,
by Drs. Hallowell and Ratey
Healing ADD,
by Dr. Daniel G. Amen
The Attending Physician,
by Dr. Stephen Copps
Diagnosis and Treatment of Brain
Chemical Imbalance,
by Martin T. Jensen, MD
11. Good FMS resources:
www.hometown.aol.com/kathyfms/
www.fmnetnews.com
www.sover.net/~devstar/
www.sounddoctrin.com
ATTENTION DEFICIT DISORDER
DIAGNOSTIC
CRITERIA
INATTENTION
1. Often has trouble sustaining
attention in tasks
2. Often does not seem to listen
when spoken to directly
3. Often has trouble organizing
activities
4. Often avoids or is hesitant about
engaging in projects that require
sustained mental effort
5. Often loses things
6. Often does not give close
attention to details or makes
careless mistakes
7. Often does not follow through on
instruction or does not finish
tasks.
8. Is often easily distracted by
extraneous stimuli
9. Is often forgetful in daily
activities
Total____(Inattention)
HYPERACTIVITY
1. Often does not like to remain
seated, even when being seated is
expected
2. Often feels restless
3. Often fidgets with hands or feet
or squirms in seat
4. Often talks excessively
5. Often has difficulty engaging in
leisure activities quietly
6. Is often "on the go" or often
acts like they are "driven by a
motor"
IMPULSIVITY
7. Often has difficulty awaiting
turn
8. Often interrupts others, such as
in conversations or games
9. Often blurts out answers before
questions are completed
Total_____(Hyperactivity-impulsivity)
If
6
or
more symptoms of inattention or
hyperactivity-impulsivity have been
a problem for at least 6 months, the
patient should be evaluated by
someone who specializes in adult
attention deficit disorder.
There are very good ADHD criteria on
this site for women with attention
deficit disorder.
The secret of the LORD is with
them that fear him;
and he will show them his covenant.
Psalm 25:14
For as the heaven is high above the
earth, so great is his mercy toward
them that fear him. Psalm 103:11
