Episode 32: What is New in Research on Brain Fog in 2026?

Many patients with fibromyalgia and chronic pain complain about difficulty with memory and focus.

Join Dr Karmy for an interview with Ronessa Dass MScOT/PhD candidate from McMaster University, who will discuss her research on brain fog, including diagnosis and treatments for this condition.

If you have any questions for Dr. Karmy, feel free to email us at karmychronicpain@gmail.com

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Transcript

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You do need an interdisciplinary approach, and you do need to target all of those different biopsychosocial factors to help to support people with chronic pain. And I think that's very similar for brain fog as well. Just the key consideration is then even though all of those strategies might be helpful, brain fog might make it harder for people to use those strategies. Welcome back to Chronic Pain Chronicles with Dr. Karmy. In today's episode, he tackles one of the most common and most misunderstood symptoms we hear from patients with chronic pain, brain fog. If you've ever walked into a room and forgotten why, struggled to find a word mid-sentence, or felt like your thinking was just slow and cloudy, then you know what we're talking about. But what exactly is brain fog? Is it a real medical condition? Can it be measured? And what can be done about it? So in this episode, Dr. Karmy interviews guest Ronessa Dass, a PhD and master's candidate at McMaster University, where she works in the IMPRinT lab under Dr. Tara Packham at McMaster University. Ronessa's research focuses on building a proper evidence-based definition and measurement tool for brain fog. So let's get into it Dr. Karmy started by asking Ronessa what exactly is brain fog? Because before we study something, we need to know what we're talking about. It is, "Brain fog is a phenomenon of instances of mental cloudiness that can produce cognitive and emotional impacts, causing difficulties with completing daily tasks and goals, and the impacts can act on a cycle to reinforce the symptoms of brain fog and defer from engagement with evidence-based strategies for comorbid conditions." What struck us about that definition is the emotional component. It's not just a cognitive thing, and critically, brain fog can actually make it harder for patients to use the very treatment strategies we'd normally recommend. That's a real clinical problem How was the definition developed? Ronessa didn't just come up with that definition out of thin air. Her team went through a serious research process, and she explains it well here. So the first step that we did was a scoping review, and this was to get a lay of the land and see what was out there in the literature, and that helped us to shape our initial definition. And then from that definition, we then performed a qualitative study where we were able to elaborate on it, with discussions with people with lived experiences. And then our current study, what my PhD is working on, and this part hasn't been published yet, but we're in the process of peer review, where we established a theoretical framework of brain fog. And then we're now using that framework to develop a self-report questionnaire of brain fog. So they're building toward a questionnaire, a scoring tool that would let clinicians actually quantify brain fog the way we quantify pain or depression. That's a big deal. Right now, there's no validated test for brain fog. So what triggers brain fog? One of the most useful parts of the conversation was when Ronessa walked through the four categories of triggers that their research identified. This came out of interviews with people who actually live with brain fog, so it's grounded in real experience. So our four categories of potential triggers are trauma. So people often describe brain, feeling brain fog more after traumatic experiences, but also pain in itself is traumatic. The second category that we have right now are body imbalances, so things like changes in hormones. Women might feel it more after menopause. Potentially stress, but also eating unhealthy foods. Then our third category is sensory overload. So people describe feeling brain fog more in loud or busy places. And the last category is physical and mental exhaustion, so people often experience it when they have sleep disturbances or at the end of a long day. Sleep, stress, hormones, sensory environment. If you're a chronic pain patient listening to this, you probably recognize all of those, and I think this is why brain fog feels so tied to the overall experience of living with pain. It's not separate from it. Ronessa also made an important distinction that's worth pausing on. So we don't exactly look at, deep-rooted mechanisms, but we're mostly looking at what might trigger it, and we're noticing, it might be - sleep issues, it might be depressive symptoms, it might be more pain intensity or pain interference. And I don't know if you can really say that it's a one or the other, because even with pain, it's usually all of those factors working together, and qualitatively that's what we found as well, is that people can't really link it to one factor. It's usually all of these things working together. But we have seen, mostly within our study, people tend to describe it with mental health symptoms as well. Another kind of a side note, there's a condition called, post-concussion syndrome. Or minimum brain injury. Which often is associated with a lot of the same cognitive symptoms. And then patients with things like fibromyalgia without a concussion can have, again, these same cognitive symptoms. Is there a difference between them? Some scholars argue that it falls under the larger umbrella term of cognitive dysfunction, and that they're all might be variations of that. And then there are other scholars out there which say that these things are actually different, and that because brain fog is prevalent in so many different types of conditions, and it's defined fairly similarly across those different conditions, then that,, gives reason for it to be categorized as something on its own., But I believe that topic is still a little bit debated. Something that came up that is really important and honestly underreported is the gender dimension of brain fog management. It's not just about who gets it, but about who has the resources to deal with it. So in our study, women describe having a harder time managing brain fog along with other competing priorities, so things like taking care of children, household responsibilities, going back to work, all while managing their health. And men in our study describe offloading a lot of those tasks to their women spouses. And from a traditional gender role perspective, we know that those types of caregiving roles, those are ones that women tend to take on, and they often don't have anyone that they can offload those tasks to. And in fact, when we asked women which management strategies they use, most didn't describe the use of any, instead advocated further development in future work. That's a sobering finding. It tells us that the social context around a patient matters enormously and that a treatment plan that works on paper might not work for someone who is also the primary caregiver at home. Ronessa also flagged something that's easy to overlook. In some cases, brain fog doesn't just sit alongside other symptoms. It can actively get in the way of treating them It's also been shown in the long COVID literature that because a lot of the strategies that we use in rehab and in pain do require some sort of cognitive component and do require that attention and that memory, that it's likely that persons who are experiencing brain fog might have trouble engaging with those treatments. So for treatment, what can we actually do? Because patients always want to know what helps. The honest answer is it depends and it has to be individualized. But Ronessa laid out a really thoughtful framework It has to be very personalized, very individualized. And usually it should be multiple strategies, right? And we know that's what's needed in pain management in general. You do need an interdisciplinary approach, and you do need to target all of those different biopsychosocial factors to help to support people with chronic pain. And I think that's very similar for brain fog as well. Just the key consideration is then even though all of those strategies might be helpful, brain fog might make it harder for people to use those strategies. So we might need to think about creative approaches to help to make those strategies a bit more accessible. and she gave some really practical examples of what that looks like. If it's in a clinical setting, we send people reminders so that they're able to remember to go to their appointments and take their medications. We're giving people things that they can use at home, making sure that our education sources are, within our lay so people can understand how to use them. And we're also really, , leveraging the social contacts that people exist in as well. So maybe we're providing information to employers so they can provide accommodation so that people can continue to work and have that sense of self. Or we're reaching out to the family so that the family can help to provide those reminders Dr. Karmy did ask about supplements for brain fog, and Ronessa gave a really measured answer that I think is worth hearing directly. we did a social media discourse analysis where we actually saw that people were trying to sell things like supplements and vitamins for brain fog. So things that really were not evidence-based, and they were trying to sell it because they know that there's a market for those things. People with chronic pain spend so much money out of their own pockets to help to manage their pain. And we even saw that they were using messaging like, "Your healthcare professional doesn't believe you, but we do." So then they try to sell them that vitamins. So I think people just have to be cautious of that and really look at the evidence when it comes to what supplements or what strategies out there might be helpful. On medications, the picture is complicated. Some pain and mental health medications can actually help by addressing the root cause, but others cause drowsiness and cloudiness that make brain fog worse. This is another reason why individualized care matters so much although brain fog is a frequently mentioned complaint, we are just now starting to develop a formal definition of what it is. There is no MRI or blood test for it, and definition relies on self-report. So generally speaking, it is a diagnosis of exclusion. In other words, we only diagnose patients with brain fog if all the imaging and lab tests, as well as a sleep study, are normal. In terms of treatment, most of the approaches focus on treating the conditions associated with the brain fog, such as pain or depression or menopause, in hopes that as these conditions improve, the brain fog will improve too. We do not have evidence-based treatments for brain fog specifically at this point. I want to thank Ronessa Dass for taking the time to join us. This was a really valuable conversation. Thank you for listening to this episode of Chronic Pain Chronicles with Dr. Karmy. our goal is to bring you clear evidence-based insight so you can make informed decisions about your care. When it comes to your health, always consult with your own physician or healthcare provider for personalized advice and guidance. The information provided in this podcast is for educational and informational purposes only and should not be considered medical advice or a substitute for professional medical care