# Planning and Problem-Solving Impairments in Fibromyalgia: The Predictive Role of Updating, Inhibition, and Mental Flexibility

## TL;DR

This study shows that fibromyalgia patients have impaired planning and problem-solving abilities, which are linked to basic executive functions like updating, inhibition, and mental flexibility.

## Contribution

The study is the first to describe how basic executive functions influence high-order planning and problem-solving in fibromyalgia patients.

## Key findings

- Fibromyalgia patients scored lower in visuospatial working memory and planning/problem-solving tests.
- Pain, fatigue, and sleep disturbances significantly affect cognitive outcomes in fibromyalgia.
- Updating, inhibition, and mental flexibility partially predict planning and problem-solving abilities in patients.

## Abstract

Background/Objectives: Fibromyalgia syndrome (FMS) is a chronic pain condition in which executive function (EF) alterations have been reported, though strikingly, relationships between simple executive functions (EFs) (updating, inhibition, and mental flexibility) and high-order ones, such as planning and problem-solving, have not been addressed yet in this population. This research aimed to firstly explore how low-level EFs play a role in planning and problem-solving performances. Methods: Thirty FMS patients and thirty healthy participants completed a series of neuropsychological tests evaluating low- and high-order EFs. Clinical and emotional symptoms were assessed with self-report questionnaires, while pain and fatigue levels were measured with numerical scales. Importantly, specific drug restrictions were accounted for. Results: Patients scored lower in most neurocognitive tests, with statistical significance noted only for visuospatial working memory (WM) and two planning and problem-solving tests. Pain, fatigue, and sleep disturbances showed important effects on most of the cognitive outcomes. Multiple regression analyses reflected that planning and problem-solving were successfully and partially predicted by updating, inhibition, and mental flexibility (though differences emerged between tasks). Conclusions: Our study confirms the presence of cognitive impairments in FMS, especially in high-order EFs, supporting patients’ complaints. Clinical symptoms play a role in FMS dyscognition but do not explain it completely. For the first time, as far as the authors know, simple EF influences on planning and problem-solving tests have been described for FMS patients. These results might help in unraveling the dysexecutive profile in FMS to design more adjusted treatment options.