Although fibromyalgia is most often associated with adults, it can affect children and teenagers as well, presenting many of the same symptoms but some differing comorbities and, for those with juvenile fibromyalgia, few treatment options. The study, “Juvenile Fibromyalgia: Different from the Adult Chronic Pain Syndrome?”, was published in the journal Current Rheumatology Reports.
Fibromyalgia (FM) in adults has been the subject of extensive research, but questions of how fibromyalgia affects and impacts children and adolescents, especially girls, are only beginning to be addressed.
The authors summarized and highlighted areas of similarities and differences between juvenile fibromyalgia and adult fibromyalgia, suggesting potential reasons for these differences. Although the onset of adult fibromyalgia is fundamentally different from juvenile onset, characteristic symptoms of widespread pain, sleep difficulties, fatigue, and function impairment are similar in both groups. Notably, recent reports suggest that psychological comorbidities are less severe in juvenile FM patients when compared to adults. As a consequence, younger patients may have more positive overall prognosis.
Adolescents with fibromyalgia often have joint laxity or hypermobility, a comorbidity rarely mentioned in adults. A recent study found that about 40 percent of juvenile FM patients had elevated Beighton scores, a measure based on the number of hypermobile joints.
Because juvenile fibromyalgia progresses to adulthood and impacts quality of life, early recognition and treatment is of immense importance.
Three medications (pregabalin, duloxetine, and milnacipran) are approved to treat FM in adults, but there are no approved drugs for adolescent cases. Most studies, accordingly, have focused on a non-pharmacologic strategy to treat juvenile FM, such as cognitive-behavioral therapy. A controlled randomized clinical trial showed that adolescents who were taught behavioral pain-coping skills showed, in a six-month follow-up period, significantly lower levels of disability when compared to control group patients. Moreover, symptoms of depression significantly decreased, reaching standard normal levels for healthy adolescents by the study’s end. Cognitive-behavioral therapy showed better results in juvenile fibromyalgia patients then in adults.
Despite significant improvements in diagnostic guidelines and age-appropriate treatments, the authors emphasized the need to continue investigating better pharmacologic and non-pharmacologic therapy choices for juvenile fibromyalgia.
Areas still lacking significant research include the underlying mechanisms in juvenile fibromyalgia and how they compare with the current knowledge on adult fibromyalgia. Such findings may allow researchers to identify early risk factors and better understand how current (and future) therapeutic strategies effectively tackle and correct these risks, possibly preventing disease progression into adulthood.