Fibromyalgia in children is a chronic syndrome with constant prevalence of pain and fatigue. It is also known as Juvenile Primary Fibromyalgia Syndrome (JPFS). Children between 13-15 yrs of age and more particularly girls manifest this syndrome.  Children with fibromyalgia may complain of constant musculoskeletal pain, tiredness, difficulty to fall asleep, etc. It may be difficult to diagnose fibromyalgia in children based on just a few symptoms. Parents must watch for more associated symptoms in order to consider a consultation with a healthcare provider.

Symptoms

• Chronic pain- without a physical exertion such as exercise;
• Tiredness- even after a day’s rest;
• Undisturbed sleep- inability to fall asleep or getting up often during sleep;
• Morning stiffness usually when getting up after sleep;
• Abdominal pain;
• Urethral syndrome;
• Irritable bowel movement;
• Headaches;
• Difficulty concentrating in school;
• Depression and
• Anxiety (Cincinnati Children’s)

Causes

Genetics, trauma (major or cumulative) and infections (mononucleosis or viral or secondary to other condition) are the main causes for fibromyalgia.

Diagnosis

There are no laboratory tests to confirm fibromyalgia. Physical examination and patient’s history from parents help in diagnosing the condition. Physical examination for fibromyalgia is determined by examining the tender points. Tender points refer to presence of pain when pressure is applied in specific body areas. Tender points for children to diagnose fibromyalgia include neck, hip, chest, thighs and buttocks. 5-7 tender points are sufficient to establish diagnosis (Kohler-Lutz, 2007).

Certain laboratory tests may be done in order to rule out other diseases or disorders such as Lupus, Chronic fatigue syndrome, osteomalacia, myofascial pain syndrome, temporomandibular joint syndrome (TMJ), bursitis, tenosynovitis, depression, growing pains, thyroid diseases, inflammatory bowel disease, hypermobility syndrome, rheumatoid arithritis, lyme disease, hypochondriasis, etc. Symptoms of these conditions often mimic fibromyalgia. (Giardiono A.P, 2008)

Apart from physical examination, other psychological assessments that are made for the diagnosis of fibromyalgia are:

Insomnia - around 80-90% is prevalent in fibromyalgia affected patients. Cognitive dysfunction is highly prevalent due to distraction or multitasking. Morning stiffness may persist between 30 minutes to more than 3 hours. (Russell and Raphael, 2008)

Differential Diagnosis

Fibromyalgia is often confused with chronic fatigue syndrome (CFS) as symptoms are very similar in both these conditions. While pain is the prime symptom of fibromyalgia, fatigue is the prime factor in CFS. A spinal fluid test to find the level of substance P will help in diagnosing the syndrome appropriately. A high level of substance P in the spinal fluid shows prevalence of fibromyalgia, whereas it is not the case in CFS. Exercise helps in improving the condition of fibromyalgia whereas it worsens the condition of CFS (Health Communities, 2007).

Treatment

Treating children with fibromyalgia is effective as high percentage of them improve at a faster rate than adults while some outgrow the syndrome. The treatment regime includes medication, exercise, diet, education and cognitive-behavioral therapy.

Medications are given reduce the degree of symptoms such as depression, anxiety, pain and insomnia.  Some of the medications prescribed are:

• Anti-depressants like amitriptyline which is a SSRI (Selective Serotonin Reuptake Inhibitor) that helps in reducing anxiety, depression and improve sleep.
• Non-steroidal anti-inflammatory drugs such as Ibuprofen, Motrin, Advil and Aleve for temporary pain relief
• Muscle relaxants like cyclobenzaprine to relax muscles and soft tissues (Goodson, 2005)
• Benadryl to improve sleep
• FDA approved drugs to treat fibromyalgia are duloxetine (Cymbalta), pregabalin (Lyrica) and milnacipram (Savella), (Cincinnati Children’s Hospital, 2010)

Though fibromyalgia cannot be cured completely, the condition can be improved and managed effectively through proper treatment regimes.

Education, Counseling and Cognitive Behavioral Therapy

Education is the key component in helping the children to manage the condition. Educating the child about the syndrome in a way he/she understands and accepts is very important. Counselor/ health care provider and parents play a vital role in educating the child in an appropriate manner. Counseling may be recommended for children with fibromyalgia who suffer from mild to moderate depression and anxiety. Cognitive behavioral therapy help a child with fibromyalgia cope with pain and fatigue through relaxation techniques, pain management, imagery, positive thinking and pacing (Cincinnati Children’s Hospital, 2010).  It found that early intervention helps children with fibromyalgia manage the syndrome well while some children even arrive at pain-free state gradually.

Managing Fibromyalgia – The parent’s role

Love, support and empathy are the key aspects to manage fibromyalgia effectively. The child needs to be emphasized that he/she is not at fault for the condition. Constant support, encouragement and empathy from the family members will help the child with fibromyalgia cope the syndrome well. It is important that the school and the teachers are informed about the child’s condition. Changes in lifestyle and change of family priorities would help the child gain confidence and emotional support.

• Other forms of treatment apart from medication which parents can provide at home are:
• Heat treatments such as massages,
• Cold applications occasionally,
• Relaxation techniques like music, (Comer Children’s Hospital, 2010)
• Distraction activities for pain management,
• Development of hobbies and interests, etc

Support Groups

Support groups help children suffering from same kind of diseases, syndromes or disorders by relating to one another. Children come to feel that they are not the only one in the whole world suffering from their kind of disease or syndrome. They realize that there are other children too who face the same challenges as they. This helps them to share their feelings, thought process, problems, ideas and coping strategies. Support groups not only include children suffering from disease or syndrome but also other adult groups such as parents, care givers, health care providers, educators and counselors.

Though there are virtual support groups for children with fibromyalgia, there are also support groups set up by NGO’s and hospitals. These support groups help children with fibromyalgia interact with real people face to face and the intervention programs designed by the support groups benefit them in managing fibromyalgia creatively.

 

Written by: Irene J.

Edited by: Michael K. Davis, MD

 

References

1. Cincinnati Children’s, 2010, Juvenile Primary Fibromyalgia Syndrome (JPFS), Arthritis and Rheumatology Conditions and Diagnoses, http://www.cincinnatichildrens.org/health/info/rheumatology/diagnose/jpfs.htm
2. Comer Children’s Hospital, 2010, Fibromyalgia, http://www.uchicagokidshospital.org/online-library/content=P01716
3. Goodson D.C, 2005, Fibromyalgia in Children, http://health.learninginfo.org/fibromyalgia-children.htm
4. Giardino A.P, 2008, Fibromyalgia: Differential Diagnoses & Workup, http://emedicine.medscape.com/article/1006715-diagnosis
5. Health Communities, 2007, Fibromyalgia, Differential Diagnosis http://www.neurologychannel.com/fibromyalgia/index.shtml
6. Kohler.J, Lutz, 2007, Fibromyalgia in Children, The FMS Community, http://www.fmscommunity.org/pediatric.htm
7. Dr. Pellegrino M.J, 2010, Fibromyalgia in Children & Teens - Risk Factors, Symptoms, and Treatment, Prohealth Library, http://www.prohealth.com/library/showarticle.cfm?libid=15168
8. Dr. Russell.I and Raphael, 2008, Fibromyalgia Syndrome: Presentation, Diagnosis, Differential Diagnosis, and Vulnerability, CNS Spectr. 2008;13:(3 Suppl 5):6-11 http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=1494