Long-Term Outcomes of Adolescents With Juvenile-Onset Fibromyalgia in Early Adulthood

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition, typically identified in adolescence and accompanied by physical and social impairment and mood difficulties. There are no long-term studies on the prognosis of adolescents with JFM into adulthood. WHAT THIS STUDY ADDS:This prospective study demonstrated that pain and other symptoms persisted into adulthood for .80% of JFM patients, with associated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adult fibromyalgia. abstractOBJECTIVE: This prospective longitudinal study examined the long-term physical and psychosocial outcomes of adolescents with juvenile-onset fibromyalgia (JFM), compared with healthy control subjects, into early adulthood.METHODS: Adolescent patients with JFM initially seen at a pediatric rheumatology clinic (n = 94) and age-and gender-matched healthy control subjects (n = 33) completed online measures of demographic characteristics, pain, physical functioning, mood symptoms, and health care utilization at ∼6 years' follow-up (mean age: 21 years). A standard in-person tender-point examination was conducted. RESULTS:Patients with JFM had significantly higher pain (P , .001), poorer physical function (P , .001), greater anxiety (P , .001) and depressive symptoms (P , .001), and more medical visits (P , .001) than control subjects. The majority (.80%) of JFM patients continued to experience fibromyalgia symptoms into early adulthood, and 51.1% of the JFM sample met American College of Rheumatology criteria for adult fibromyalgia at follow-up. Patients with JFM were more likely than control subjects to be married and less likely to obtain a college education.CONCLUSIONS: Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers.

Parenting in the Context of Chronic Pain

“…The two study groups also differed on a number of socioeconomic demographic characteristics, including parent age. Of note, recent work following individuals with juvenile fibromyalgia suggests that women with chronic pain may be more likely to marry at a young age [65], a finding which may account for the age differences observed between the parent groups in our study. We were able to statistically control for some of these factors in our analyses, though this was not the primary focus of the current study, which recruited children of similar ages and genders in both groups.…”

Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

“…Children with chronic pain may experience significant impairment, including increased healthcare utilization (3, 4), academic difficulties and social problems (3). For a large number of youth with chronic pain, symptoms persist for five years or longer (5-7). Cognitive behavioral therapy (CBT) focused on pain coping skills training is known to improve outcomes for youth with chronic pain in research trials (8-10) and in clinical settings (11, 12).…”

A 14-Year-Old With Diffuse Musculoskeletal Pain

“…Additionally, juvenile fibromyalgia was associated with impaired physical functioning, lower perceived health status, and higher health care utilization compared with healthy controls of similar age. 7 While the pathophysiology is not well understood, current theory views fibromyalgia as central nervous system malfunction leading to pain amplification via altered transmission and reception signals. 8 This malfunction may be linked to a dysfunction in the hypothalamic-pituitary axis as many of the symptoms experienced by patients with fibromyalgia mimic those seen in patients with endocrine dysfunction, specifically thyroid dysfunction.…”