Fibromyalgia (FMS) and Attention Deficit Disorder
(ADD) / ADHD
--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.add-fibromyalgia.com
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.
www.addvance.com/resources/Articles/Checklist2.htm
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
