A preliminary study of the child abuse and central sensitization in adolescent patients with chronic non-organic chest pain and an overlooked condition: juvenile fibromyalgia syndrome

Abstract

Background: Only a small percentage of pediatric chest pain is of cardiac origin and the most common detected cause is musculoskeletal. Among musculoskeletal causes, acute chest pain is better described, with the causes of chronic pain not being adequately investigated in the literature. The aim of studuy is to evaluate the musculoskeletal causes of non-cardiac chest pain and investigate the relationship of chest pain with child abuse and central sensitization. Methods: Patients aged 12 to 18 years presenting with chest pain for at least 3 months were evaluated by a pediatric cardiologist and those without an organic pathology were referred to the physical medicine and rehabilitation clinic. In addition to detailed history and physical examination, juvenile fibromyalgia was questioned according to the 2016 revised diagnostic criteria of the American College of Rheumatology. The visual analog scale (to measure intensity of chest pain), the Central Sensitization Inventory (to evaluate the presence of central sensitization), the Hospital Anxiety Depression Scale (to determine depression and anxiety), the Childhood Trauma Questionnaire (to assess the presence of child abuse) were administered. Results: The study was completed with 64 patients. Twenty-six percent of patient (n = 17) were diagnosed with juvenile fibromyalgia, and central sensitization was detected in 34.4% (n = 22). Pain intensity, anxiety, depression and abuse scores were higher in patients with juvenile fibromyalgia than those without juvenile fibromyalgia and in patients with central sensitization compared to those without central sensitization (p < 0.001 for both). Higher scores of pain were related with child abuse [beta = 0.763, p < 0.001, (%95 CI, 4.397; 8.841)] and central sensitization of pain [beta = 0.382, p = 0.008 (95% CI: (0.986;6.231)] in regression analyses. Conclusion: In this study, juvenile fibromyalgia was detected as a cause of non-cardiac chest pain. Juvenile fibromyalgia or central sensitization may also indicate childhood abuse.

Functional difficulties mediate the association between exposure to adverse childhood experiences and headaches among children: Findings from a population‐based study

“…Experiencing violence and victimization have been found to result in various pain conditions such as low back pain, abdominal pain, and fibromyalgia. 68,69 Experiencing violence and victimization have also been found to result in prolonged activation of the body's stress-response system thereby resulting in increased allostatic load. 70 This increase in allostatic load could lead to pro-inflammatory cytokines or a breakdown of the hypothalamic-pituitary-adrenal axis which acts to regulate stress responses in the brain following a disturbance.…”

“…Experiencing violence and victimization have been found to result in various pain conditions such as low back pain, abdominal pain, and fibromyalgia 68,69 . Experiencing violence and victimization have also been found to result in prolonged activation of the body's stress‐response system thereby resulting in increased allostatic load 70 .…”

Do “central sensitization” questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses

“…58 showed moderate-strong weighted correlations with the CSI. There wasn't sufficient data for a meta-analysis on childhood trauma, somatization, and personality type (sensory profile and brief resilience scale) and negative affect but they all showed moderate-strong correlations with CSI [20,21,23,41,50,73,77]. Overall, these findings suggest that the CSI correlates strongly with psychological factors (see Supplementary Table 1A and Figures 4a-b).…”

Juvenile primary Fibromyalgia Syndrome: epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis

“…These symptoms may be more common in children with disease onset prior to the age of ten years, as shown in a study of 148 JPFS patients by Eraso et al [ 11 ]. Chronic chest pain in adolescents may be another manifestation of JPFS [ 85 ].…”