Anxiety and Cognitive Impairment Worse in Fibromyalgia than Other Rheumatoid Disease

man wringing hands in painUpdated October 2019

Rheumatic diseases are characterized by changes in the joints, pain, and inflammation.  People with fibromyalgia are very often referred to as having a rheumatic disease; however, that is not always the case.  In fact, it is detrimental to consider fibromyalgia as one system classification since it involves every area of the body. While many of their pain symptoms do involve the joints, there are bigger issues at play with fibromyalgia.

Fibromyalgia is one of the most common chronic pain conditions rampant in the United States.  It affects the central nervous system and has symptoms ranging from excess fatigue to widespread pain.  Other symptoms include increased sensitivity to chemicals and foods, depression, anxiety, sleep disturbance, and poor immune functioning. Of important note here is that fibromyalgia causes significant psychological distress and impaired cognitive functioning (fibro fog).

A recent study that was presented at the American College of Rheumatology Annual Meeting in Boston reported that those with fibromyalgia are at increased risk for presenting with symptoms of anxiety compared to those with arthritis and other rheumatologic diseases.

Fibromyalgia is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the U.S. and an estimated 3-6% of the world population. While it is most prevalent in women —75-90 percent of the people who have FM are women —it also occurs in men and children of all ethnic groups.

In the above study, the team looked at 191 people with a rheumatic disorder.  Of these, 79 had fibromyalgia, and the other 112 had some other type of rheumatic disease.  There was an age difference between the groups.  Fibro patients had an average age of 51.2 years and the others had an average age of 51.9 years.

Each of the participants were evaluated for anxiety along with a rheumatologic symptom checklist covering 13 organs.  The fibro patients had higher scores on eight of nine items that assessed anxiety.  The second group showed normal anxiety levels.  There were also higher levels of illness and symptom intensity in fibromyalgia patients compared to those with other rheumatic diseases.  Even adjusting for this, fibro patients were still more likely to have anxiety.

sad woman faceAt this same annual meeting, researchers reviewed the effect on cognitive functioning in patients with fibromyalgia and rheumatoid arthritis.

As mentioned, fibromyalgia heavily effects the central nervous system, causing abnormalities in the way pain is processed by the brain.  The symptoms of fibro, unfortunately, lead to psychological distress, and patients are often “written off” as simply having a mood or personality disorder.

It is not uncommon for fibromyalgia patients to be diagnosed with cognitive impairments.  It’s no wonder with what is being depleted from their bodies and the number of medications they are prescribed!  They suffer what is called “fibro fog,” which impairs concentration, focus, and memory.  The researchers at Rush Medical College in Chicago who presented the findings at the annual meeting wanted to analyze and address the extent of cognitive impairment in fibro patients compared to those with rheumatoid arthritis.

The scientists looked at 211 patients, 61 of which had rheumatoid arthritis and 150 of which had fibromyalgia.  Cognitive functioning was assessed by using a questionnaire about experiencing symptoms of impaired mental function.  This questionnaire was rated with patients reporting occurrence of symptoms on a scale from 1 (never) and progressing to 5 (all the time).

It was found, and not surprisingly, that patients with fibromyalgia had significantly higher scores of experiencing symptoms of cognitive impairment when compared to those with rheumatoid arthritis.

The following symptoms were determined to be worse in fibromyalgia patients:

  • “Inability to recall known words.”
  • “Mistaking numbers that look similar.”
  • “Inability to write an idea down.”
  • “Inability to retain patterns when adding, subtracting, multiplying or dividing.”
  • “Distraction by background noises.”
  • “Difficulty following directions.”
  • “Trouble following conversations.”
  • “Becoming disruptive in conversations.”
  • “Misremembering spelling of familiar words.”
  • “Losing place while reading.”
  • “Difficulty expressing thoughts verbally.”
  • “Poor reading comprehension.”
  • “Frustration when speaking.”
  • “Difficulty concentrating.”


deep restorative sleep is keySound familiar?  Fibro fog is a very real problem in those with fibromyalgia, and I have found that the first thing that needs to be fixed is the problem with sleep.  Most of my patients come to me with sleep disturbances (trouble falling or staying asleep, sleeping too much, excess daytime sleepiness, etc.).  Poor quality sleep reduces the intensity of many of the symptoms.  Restorative sleep is vital for life and health.  It is when we restore our body’s natural chemical and hormonal make-up.  Without enough restorative sleep, your body is not able to fully recuperate, and that, as you well know, will lead to further deterioration.

While there may not be a cure as yet for fibromyalgia and the physical and psychological distress it causes, there is absolutely a way to reverse and reduce your symptoms.

If you have any questions regarding this post, or any others on my site, I host a FREE Facebook LIVE each week, where I will answer one-on-one questions for people who are looking for alternative treatment methods or have any questions about my posts and recommendations.

Join me this Wednesday at 8 p.m. EST, 7 p.m. CST, 6 p.m., and 5 p.m. PST.  ON FACEBOOK LIVE!  If you haven’t already done so, you can register for the free Fibromyalgia Video Series by visiting:

I look forward to answering any questions you may have.

10 replies
  1. Arlene Caissie
    Arlene Caissie says:

    I am very excited yo hear conference call. I have been DX. Since 2000 at 50yrs. old. By Dr. MICHAEL
    KOHEN, a Rumatologist, and works with Fibromayalga.
    In Daytona Beach, Florida. I was also Dx. With Systemic Lupus, I had positive Ana test, but afterI
    Had a DNA done, and was told, I didn’t have Lupus.
    So very anxious, to see how this works out.
    Looking forward, till Tues. Than you, for taking me on. Respectfully, Caissie.

  2. karla
    karla says:

    I appreciated your article about cognitive impairment in fibro patients, as I have had fibro for several years. A request, please: Make the type of your articles darker and larger. It would make for easier reading for those of us with fibro. It’s very difficult to read such light type. I had to enlarge it several times over. Thank you.

  3. Crystal
    Crystal says:

    I suffer from fibro and sjogrens syndrome and also ADHD. I only sleep 3 to 6 hours a night. What advice could you give to help me rest and maybe not hurt so bad?

  4. Barbara
    Barbara says:

    Hi iwas diagnosed with fibro in 1996. My pain level got worse as the years went by. Now I not only have deep muscle pain and muscle fluttering that ive been reading is associated with fibro in my calves, ankles, neck, head. I also feel movements like bubbles in arms, shoulders, back and legs. Is this restless leg syndrome? It never stops. I feel very anxious as if im always on edge,waiting for something to happen. It is difficult to sleep with pain and anxiety. Ive taken muscle relaxers, lyrica, vitamins, pain pills but nothing works. The fluttering really annoys me. What can I do?

  5. Diane
    Diane says:

    Dear Dr. Murphree,

    Have you been doing any statistical studies among your patients, to find out how many people have common causes, or common illnesses, that lead to the diagnosis of fibromyalgia?
    I self-diagnosed in 1999 with Fibromyalgia, age 39, after having terrible achy pain in my upper legs since I was in my late teens. I had also had very serious IBS, depression, heavy periods, migraines, tenseness and irritability, trouble sleeping, lack of energy, trouble running/jogging, and complicated pregnancies, (being RH-, with 2 miscarriages, and 2 healthy babies by C Section). I also had double joints, and did not know at the time, also knock-kneed.
    You have probably already guessed what I learned 3 years ago. As I was losing more short term memory and my Mother was being diagnosed with dememtia in her 70’s, I asked for a CT Scan to check for Multiple Sclerosis. My legs would twitch at night, I got awful Restless Leg Syndrome, felt like I wanted to jump out of my skin!! Was fatigued during the day but unable to nap, and my husband’s snoring kept me from sleeping well at night.
    My CT Scan was read by the technician, and a “Chiari 1 Malformation” was noted. My primary care doctor took this news very casually, telling me there was “little you can do, unless you WANT brain surgery”. I didn’t research it further, until I stumbled upon several facebook support groups for Chiari and other Diseases and Syndromes. After reading all the things I had in common with these patients, most of them younger than I am, I went to a neurologist and had another CT Scan done. There was the same result, I had a Chiari 1. It was, in my case, a birth defect that would never have been found without the MRI Equipment. FINALLY, I had a common originator for at least 2/3 of the Fibromyalgia Symptoms that have plagued me all my life!! I am afraid to have surgery to correct the descending of my cerebellum into my spinal canal which causes over crowding of nerves, veins, and disrupted flow of cerebral-spinal fluid. There is a 40% failure rate and a lot of exploratory type surgery going on, with many patients, including children, being damaged for life and made worse than before!
    In addition, it is being found that a large majority of these Chiari patients often have Ehlers-Danlos syndrome, and suffer from the side effects of this collagen related disorder. Another form is called Vascular Ehlers-Danlos Syndrome, which can affect heart valves, veins, and arteries…causing POTS which is mis-diagnosed as Raynaud’s syndrome, black-outs, dizzyness, inability to drive, fibro fog, and more.
    Many of these diseases are inter-connected and related and often present together, as in my case. It took me 15 years of my own medical research to find these diseases, by connecting dots from symptom to disease and then ruling them in or out one after the other. This should have been my doctor’s job, but they just passed me from one specialist to another without diagnosing a condition or a treatment.
    I lost my marriage, I am unable to work a regular job, I sleep too much and I suffer terribly when pressure changes affect my joints. I still have IBS, and many other conditions. I think I have one of the best drug regimens, which includes: Clonazepam, Gabapentin, Prozac, Morphine IR 15 and ER 30, and Tizanadine, and I have already tried all the new and old drugs; the SSRI’s, Lyrica, Cymbalta (almost killed me with depression), and all the different pain relievers (which aggravated my stomach and kidneys).
    On top of finally learning about what I “really” have, and realizing that the doctors who said “Fibromyalgia is what you have when they don’t take time to find out what is really wrong, or it hasn’t fully presented yet”, and these same doctors took advantage of the Pharmaceutical companies Perks and Bonus programs for new Fibro drugs, instead of finding the real source of the diseases. So many people have been improperly treated, operated on, used as drug trial guinea pigs, and surgical living cadavers for brain surgery! I doubt this letter will go to print in your publications, for the huge surge of new patients that will be diagnosed with the real cause of their Fibro.
    Have you also found these syndromes to be in common, and are you working on a complimentary treatment plan or protocol for a patient, perhaps in the form of a workbook to guide them through the flowchart of symptoms, tests, diagnoses, treatments, and follow up care?

    I look forward to your reply and ask you to please publish this letter so that others may become more aware of these not-so-rare conditions, and their potential causes (such as drinking alcohol when pregnant while the spinal canal is forming), and that some of the diseases and syndromes are hereditary and/or are more predominant in certain races or ethnicities, and can be passed on to the next generation, or detected prior to conception by DNA testing!

    I would also like to suggest a new category of Physicians and Surgeons who are specially trained, and re-educated with the most current and best forms of treatments and surgeries, follow up and maintenance, so that this huge generation of Guinea Pigs who are PEOPLE shall have correct and proper treatment, and some place to go when the receive the “blanket diagnosis” of Fibromyalgia, for further testing!

    D. Crockett

    4459 S. round Hill Dr.
    St. George, UT 84790 (confidential please)


    July 5, 2015

  6. Diane
    Diane says:

    P.S. my other conditions include: hiatal hernia, adrenal adenoma, vasoconstriction, bilateral peripheral neuropathy, vagus deformities in my wrists, elbows, and knees, ie. double-jointedness or knock knees, osteoarthritis, skin signs of vascular rash, lupus like patterns on ANA tests, with speckled patterns but no definite diagnosis, Chiari 1 malformation, migraines and weak neck/head – cranio-cervical junction, displaced disks in c4,c5, t,6,7, and L 1,2, possible tethered cord, tightened ligaments, spider and varicose veins, cherry angiomas, unusually youthful skin on face and hands, thin papery or velvety skin, thin scars, easy scarring, stretch marks, transparent skin showing blue veins predominantly, Post Arthotic Tachicardial Syndrome – POTS, Raynaud’s-like darkening of hands and or feet (not caused by cold temperature, caused by vasoconstriction) , Angina and “Clothes-Hanger Pain Syndrome), RH-, B-, C-sections and early miscarriages, and more.
    :Dc 7-5-15


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