Fibro Fog

Sleep, brain dysfunction likely culprits for cognitive difficulties associated with fibromyalgia.


Fibro fog – also known as fibromyalgia fog and brain fog – is a term commonly used for the cognitive difficulties that can occur with fibromyalgia.

What is Fibro Fog?

“My patients tell me that fibro fog feels like they’ve been taking cold medicine constantly,” says Rob Keenan, MD, MPH, assistant professor of rheumatology at Duke University School of Medicine. “They have difficulty concentrating, finding words, holding conversations, feeling alert and remembering things.”

According to a 2015 review in Rheumatology International, some patients report that the loss of mental clarity can be even more devastating than the pain and fatigue associated with fibromyalgia. Fibro fog can manifest itself in different ways in different people but some of the most common symptoms include:

  • short term memory loss
  • misplacing objects
  • becoming easily distracted
  • forgetting plans
  • difficulty carrying on conversations
  • inability to remember new information

Although cognitive difficulties have sometimes been thought of as “all in a patient’s head,” a 2015 study in Arthritis Care and Research found that fibro fog is a real issue. In a study of 60 individuals – 30 with fibromyalgia and 30 without fibromyalgia – researchers found various impairments of attention and memory in fibromyalgia patients when compared with healthy controls. What remains unclear is what is causing the cognitive challenges.

Sleep Better, Feel Better

Though the cause of fibromyalgia fog is still up for debate, many physicians and researchers theorize that fibro fog could be related to poor sleep.

“The first thing I ask my patients is how well they’re sleeping,” says Dr. Keenan. “Most will tell me that they’re waking up several times during the night or lying awake for hours. Goal number one becomes getting them to sleep well, which can help them feel sharper, as well as help them better deal with pain.”

Dr. Keenan often tackles sleep issues using a combination of tactics.

“I often prescribe patients amitriptyline (Elavil), which helps people reach the level of restorative sleep they’re often missing with fibromyalgia,” says Dr. Keenan. “I also recommend that they get as much activity during the day as they can handle, whether it’s walking 50 feet down the street or getting into a warm pool to exercise. Good sleep hygiene also is important.” 

Is the Brain to Blame?

Though better sleep has many benefits, some studies show there are simply different things happening in the brains of people with fibromyalgia. In one study, brain scans showed that from time to time, people with fibromyalgia do not receive enough oxygen in different parts of their brain. One possible reason is that part of their nervous system is off-kilter, causing changes in the brain’s blood vessels.

Additional research – though not on fibromyalgia specifically – showed that chronic pain may affect the brain. Functional MRI found that in people with chronic pain, a front region of the brain mostly associated with emotion is constantly active. The affected areas fail to shut off when they should, exhausting neurons and disturbing the balance of the brain as a whole.

A 2013 review in Current Pain and Headache Reports on cognitive impairment in fibromyalgia patients confirmed that the jury is still out on the exact cause of fibro fog. However, it did report that patients may see some cognitive improvement with a combination of physical activity, cognitive-behavioral therapy and medication.

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