Diagnosing Children and Adolescents with Fibromyalgia

Although fibromyalgia was previously considered to be a syndrome that only impacted adults, typically those over the age of 50 and predominantly women, there is the possibility that children and adolescents may also have the syndrome. Typically the tender points associated with adult fibromyalgia are also present in children but are often overlooked or not considered in a standard pediatric examination. Children may also have fewer tender points than the typical adult diagnosed with fibromyalgia. However, doctors may begin to suspect fibromyalgia if there are significant stress related types of complaints of pain. These are typically found with conditions of psychosomatic and recurrent abdominal pain.

In a study of 47 children ranging in age from a low of six years to a high of 17 years with recurrent abdominal pain and stress, it was found that all children in the test scored for tender points close to the maximum possible level. In addition eight of the children met the diagnosis for fibromyalgia tender points and were subsequently diagnosed. In follow-up examinations, children that had pain being controlled scored lower on both stress and fibromyalgia tender point tests than those that still experienced chronic abdominal pain. 1

These researchers concluded that children with chronic psychosomatic pain do have an increased risk of developing fibromyalgia compared to children that had a favorable outcome with pain management treatment. In addition, researchers proposed that the number of tender points and the duration of pain may also play roles in the future development of fibromyalgia.

Symptoms of Fibromyalgia in Children

One of the biggest difficulties in determining a diagnosis of fibromyalgia in children is the variety of symptoms and the child’s inability to accurately report pain. The other complication is that parents and physicians may fail to understand or to acknowledge the symptoms that the child is experiencing or attribute the symptoms to other health issues, growth or normal development.

Researchers have developed a name for fibromyalgia that develops in children but is usually not diagnosed until the teen years. It is now recognized as Juvenile Primary Fibromyalgia Syndrome or JPFS.2  Often the diagnosis is difficult and lengthy but can be more easily determined if a first degree family member also has a diagnosis or the symptoms of fibromyalgia. This includes a parent or an older sibling. It is estimated that approximately 75% of all teens and children diagnosed with JPFS will have at least one family member that has a diagnosis or symptoms of fibromyalgia.

The symptoms of fibromyalgia in children and teens are similar to the symptoms noted in adults. A very common complaint is increased fatigue, which is often overwhelming for children and teens.

Other major symptoms include the presence of chronic musculoskeletal pain that may flare or remain relatively chronic and constant. Since this may not be reported by the child or teen to the parent it may be very difficult to determine. In addition kids often experience pain that is attributed to “growth pains”, particularly during periods of rapid bone growth and development. These pains usually resolve after a few weeks to months and are not chronic as seen in fibromyalgia.

Symptoms other than fatigue and pain, including the presence of the tender points recognized by the American College of Rheumatology criteria, can include tight muscles, some muscle or joint swelling without injury, anxiety, depression, irritable bowel syndrome, dizziness and difficulty in concentrating. Some children may also develop extreme to mild abdominal pain and headaches. Muscle stiffness in the morning is also common, but this will dissipate over the day only to return again the next morning. This often doesn’t change even with exercise or stretching.

Common Irritants to JPFS

Unfortunately many well-meaning parents and even physicians may recommend specific activities that can increase the pain of fibromyalgia. This includes the recommendation to increase exercise, particularly strenuous types of exercise or exercise that is done in short intense bouts. It is more effective for children with fibromyalgia to increase their exercise intensity and duration slowly and to focus on low impact and moderate intensity and duration exercises. This may include walking, swimming or cycling three to five times a week for periods of no more than 30 minutes per workout. As fibromyalgia pain decreases, the intensity and duration of exercises can be gradually increased. In studies, moderately intensive aerobic training over 12 weeks showed improvements in physical ability, pain, symptoms and quality of life for kids diagnosed with fibromyalgia.3

Lack of sleep or disturbed sleep that includes multiple wake-ups during the night is common in children and teens with fibromyalgia. As they experience increasing pain flares, sleep becomes more difficult. With less sleep, fatigue becomes more problematic as does the risk of developing depression and anxiety. Lack of sleep and fatigue also creates a decreased desire to exercise and keep active, which in turn can result in increasing risk of pain when exercise does occur. This constant cycle in children can be devastating since their bodies are already under stress in growth and changes in the hormonal responses that are changing with maturity.

Children and teens with JPFS may also have other conditions that are commonly associated with fibromyalgia. These can include depression, anxiety, sleep disorders, chronic fatigue syndrome and autoimmune disorders.  In a large meta analysis review, it was found that children with chronic illnesses, specifically fibromyalgia, have a 59% higher rate of showing depressive symptoms than healthy same age peers.4 In addition dietary concerns, specifically celiac disease, can be a major barrier to effective treatment and management of symptoms.

Failure to correctly diagnosis and treat fibromyalgia in children, along with associated syndromes or health conditions, increases the risk of fibromyalgia becoming a major issue in adulthood. If you have fibromyalgia in your family, it is important to be aware of the fact that this medical condition can also develop in children and adolescents.

References

1 Alfven, G. (2011). Recurrent pain, stress, tender points and fibromyalgia in childhood: an exploratory descriptive clinical study. Acta Paediatrica .

2 Anthony, K. K., & Schanberg, L. E. (2001). Juvenile primary fibromyalgia syndrome. Current Rheumatology Reports , 165-171.

3 Stephens, S., Feldman, B. M., Bradley, N., et al. (2008). Feasibility and effectiveness of an aerobic exercise program in children with fibromyalgia: Results of a randomized controlled pilot trial. Arthritis Care & Research , 1399-1406.

4 Pinquart, M., & Shen, Y. (2011). Depressive Symptoms in Children and Adolescents with Chronic Physical Illness: An Updated Meta-Analysis. Journal of Pediatric Psychology , 375-384.