Juvenile Fibromyalgia

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Fibromyalgia does not discriminate with regard to who it affects. Although middle-aged women are most likely to be afflicted by fibromyalgia, children and adolescents can also suffer from the condition. While some research suggests that juvenile fibromyalgia patients may have more favorable long-term outcomes than their adult counterparts (Buskila et al., 1995), other studies suggest that the symptoms of fibromyalgia tend to follow juvenile patients into their young adult years (Kashikar-Zuck et al., 2010).

Various research studies have reported the prevalence of fibromyalgia to be approximately 7% among children and adolescents who are evaluated in pediatric rheumatology clinics (Siegel et al., 1998); however, some studies have found the prevalence to be as low as 1% (Clark et al., 1998). Some authors have also suggested that the prevalence of fibromyalgia in children under the age of 10 may be under-estimated and suggest that larger, more well-designed studies are needed to better establish the prevalence of fibromyalgia in different age groups of children and adolescents (Eraso et al., 2007).

Similar to adults, fibromyalgia exerts some of its most characteristic symptoms on children, including widespread pain, fatigue, stiffness, headaches, and irritable bowel syndrome; however, research has shown that sleep disturbances and headaches tend to be more common among juvenile patients, and that children typically present with fewer than 11 tender points when using the American College of Rheumatology (ACR) diagnostic criteria for fibromyalgia (Siegel et al., 1998). Juvenile fibromyalgia patients are also at risk of developing chronic fatigue syndrome, which is a frequent comorbid condition experienced by adult fibromyalgia patients (Itoh et al., 2012).  When compared to healthy juveniles and juveniles with other pain conditions, children with fibromyalgia tend to have higher overall pain sensitivity (Ting et al. 2012; Conte et al., 2003).

Research

Siegel et al. (1998) identified juvenile fibromyalgia patients through a combination of medical record reviews and telephone interviews, in order to determine the characteristic features of juvenile fibromyalgia, and determine how it relates to and differs from fibromyalgia in adults. The researchers also sought to determine how well juvenile fibromyalgia patients respond to treatment. Forty-five patients (41 of whom were females) were evaluated for this study, and the average age was 13. After analysis of the data, the researchers found that nearly all (96%) of the children in this study experienced sleep disturbances, versus 75% of adult patients as reported in the general scientific literature. Children also tended to have more headaches than adults (71% vs. 53%), and a greater prevalence of depression (43% vs. 32%). Measures of pain and fatigue were relatively equal between the juvenile patients and the prevalence reported in the literature for adults. (Siegel et al., 1998). Of interest, other studies have also reported a high prevalence of depression and anxiety in juvenile fibromyalgia patients (Kashikar-Zuck et al., 2008), in addition to increased rates of sleeping disorders (Tayag-Kier et al., 2000).

Other research has found that the daily living environment, effective use of coping strategies, and self-efficacy all have a profound impact on the quality of life, pain, and depression levels of juvenile fibromyalgia patients (Libby & Glenwick, 2010). In addition, a 2003 study by Conte et al. found that juvenile fibromyalgia patients were more temperamental, had higher levels of depression and anxiety, and were more likely to have a dissociative family environment. Schanberg et al. (1998) also reported that children with fibromyalgia were more likely to have parents who reported a personal history of chronic pain conditions (including fibromyalgia), and that the parents’ personal histories of pain in addition to the family living environment were significantly associated with the health status of the child. Similar findings have been reported by Kashikar-Zuck et al. (2008) and Reid et al. (2005). Such observations that the family living environment and interpersonal relationships may affect how children with fibromyalgia cope with their symptoms are important in that they may help lead to the development of family-level behavioral strategies that can foster  sustainable improvements in the children’s functional status (Schanberg et al., 1998).

Juvenile fibromyalgia can also have a profound impact on the school performance and attendance of children. One study of 102 pediatric fibromyalgia patients found that approximately one-third of the students missed three of more days of school per month, and over 12% were homeschooled. This study also found that depressive symptoms were significantly associated with absences from school (Kashikar-Zuck et al., 2010). Other studies have shown that in addition to negative impacts on school performance, adolescents with juvenile fibromyalgia tend to be more isolated and withdrawn from their peers, which may have a negative impact on their ability to form peer relationships that are a pivotal part of the psychological development of children (Kashikar-Zuck et al., 2007).

With regard to treatment, Siegel et al., (1998) found that much like adults, pediatric fibromyalgia patients were likely to receive standard therapies for fibromyalgia, including tricyclic antidepressants and non-prescription pain relievers. And, although remissions and exacerbations were common, all pediatric patients included in the Siegel et al. study exhibited a positive response to their individualized therapies. Other researchers have also cited the importance and usefulness of treatment with tricyclic antidepressants and sleep therapy (Romano, 1991), as well as recommendations for regular moderate exercise (Stephens et al., 2008; Gualano et al., 2010). In addition, cognitive behavioral therapy is increasingly being recognized as an effective means of therapy for controlling and dealing with many symptoms associated with fibromyalgia in adult patients. Now, studies have begun to demonstrate its usefulness in treating a variety of symptoms – including depression, pain, anxiety, and fatigue – among adolescent fibromyalgia patients (Kashikar-Zuck et al., 2012; Degotardi et al., 2006).

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References

Arthritis Rheum. 2007;57(3):474-80.

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