Juvenile Primary Fibromyalgia Syndrome Research Articles

Overview on Juvenile Primary Fibromyalgia Syndrome

JPFS (juvenile primary fibromyalgia syndrome) is a musculoskeletal pain illness that affects children and adolescents. The intricacy of the clinical picture in JPFS has not been adequately characterized in the literature. JFMS symptoms are sometimes difficult to compare to adult fibromyalgia syndrome since many of them are "medically unexplained" and frequently overlap with other medical disorders. The etiology of the illness is multifaceted, with impaired central pain processing being a significant contributor. Musculoskeletal pain that is severe and pervasive is the defining symptom. Other signs and symptoms include headaches, stiffness, subjective joint swelling, sleep and mood disorders, and headaches. Multiple sensitive spots might be found during a physical examination. The diagnosis has certain criteria and is clinical. Early detection and treatment are crucial. The gold standard of care combines a variety of modalities, but most significantly, exercise and cognitive behavioral therapy. The outlook varies, and symptoms might last well into adulthood. Discussing the epidemiology, etiology, pathophysiology, clinical symptoms, diagnosis, and management of JPFS is the goal of the review.

VOSviewer-Based Bibliometric Network Analysis for Evaluating Research on Juvenile Primary Fibromyalgia Syndrome (JPFS).

Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome that affects children and adolescents. Methods: A VOSviewer-based bibliometric network analysis was performed by scanning the global literature on JPFS in the Web of Science (WOS) online database. The search string applied to identify the closest matching articles was “juvenile primary fibromyalgia syndrome (all field)”. Results: A total of 67 articles on JPFS were published from 1985 to March 2022, in the WOS. Regarding article types, 39 were research manuscripts, 16 reviews, 8 meeting abstracts, 2 letters, 1 book chapter, 1 correction, and 1 proceeding paper. The Quartile analysis demonstrated that 44% of papers were published in Q1, 37% in Q2, 8% in Q3, and 11% in Q4. Conclusions: Our analysis highlights that more efforts are warranted to increase the production of quality papers and enhance the connections between the various research groups. JFPS represents a research field still to be explored and which deserves greater investments to obtain quality scientific evidence.

Demographic, clinical, and treatment characteristics of the juvenile primary fibromyalgia syndrome cohort enrolled in the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry

BackgroundTo describe the demographic, clinical, and treatment characteristics of youth diagnosed with juvenile primary fibromyalgia syndrome (JPFS) who are seen in pediatric rheumatology clinics.MethodsInformation on demographics, symptoms, functioning, and treatments recommended and tried were obtained on patients with JPFS as part of a multi-site patient registry (the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry). Data were summarized using descriptive statistics. In a subset of patients completing registry follow-up visits, changes in symptoms, pain, and functioning were evaluated using growth modeling.ResultsOf the 201 patients with JPFS enrolled in the registry, most were Caucasian/White (85%), non-Hispanic (83%), and female (84%). Ages ranged from 9 to 20 years (M = 15.4 + 2.2). The most common symptoms reported were widespread musculoskeletal pain (91%), fatigue (84%), disordered sleep (82%), and headaches (68%). Pain intensity was rated as moderate to severe (M = 6.3 + 2.4/10). Scores on measures of functioning indicated mild to moderate impairment, with males observed to report significantly greater impairments. For the 37% of the initial cohort having follow-up data available, indicators of function and well-being were found to either worsen over time or remain relatively unchanged.ConclusionsThe symptoms of JPFS remained persistent and disabling for many patients treated by pediatric rheumatologists. Further study appears warranted to elucidate gender differences in the impact of JPFS symptoms. Work also is needed to identify accessible and effective outpatient treatment options for JPFS that can be routinely recommended or implemented by pediatric rheumatology providers.

Within-Day Variability of Pain and Its Relation to Quality of Life in Children with Juvenile Primary Fibromyalgia Syndrome

AbstractObjective: To determine the variability in pain intensity experienced by children with Juvenile Primary Fibromyalgia Syndrome (JPFS) and to relate within-day patterns of pain to children’s quality of life.Subjects and methods: Pain intensity was self-reported on a 0–10 cm visual analog scale by 46 young subjects with JPFS using a daily booklet chart three times a day for seven days. Forty-six healthy children and adolescents matched by age and sex were randomly recruited as controls from a pediatric clinic on a voluntary basis. Variability in pain during the day was investigated using a multidimensional pain survey that was completed three times daily in a printed booklet for one week and was related in the primary evaluation to scores for tender points and pediatric quality of life (PedsQL v 4.0).Results: Variations in pain intensity were observed during the day in patients with JPFS. The majority of JPFS patients (67%) had a high Average Absolute Change (AAC) in pain (>1 VAS unit), and a lower q...

A84: Changes over Time in Symptoms and Treatment of Juvenile Primary Fibromyalgia Syndrome

Background/Purpose:There are limited data describing longitudinal trends of symptoms and outcomes among children seeking treatment for Juvenile Primary Fibromyalgia Syndrome (JPFS). Pediatric rheumatologists often are the first point of subspecialty contact for children and adolescents with JPFS and typically evaluate the outcome of their initial treatment recommendations over one or more follow‐up visits. Using baseline and follow‐up data entered into the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry for patients with JPFS, we sought to determine the extent to which symptoms, function, and treatment recommendations change over time in this patient population.Methods:Deidentified information on symptoms, treatments, and function (CHAQ scores, subjective well‐being numerical rating scale, and 5‐point HRQOL rating scale) were extracted from the CARRA registry for all baseline and follow‐up entries between May 2010 and September 2013. Data were analyzed for 66 patients (38% of the baseline cohort) having at least one follow‐up visit recorded in the registry; the follow‐up period ranged from 0.25 to 2.5 years from baseline (M = .88 years +/− .51 years). The analyzed cohort was 82% female and ranged in age (at baseline) from 9–21 years (M = 15.0 +/− 2.28 years). Multilevel growth models were used to determine time‐related trends in symptoms, function, and treatments since completion of baseline evaluation; logistic growth models were used for models with binary outcome variables.Results:Pain scores were in the moderate to severe range at baseline (M = 6.00/10, SD = 2.74) and significantly worsened over time (b = .43 ± .19, t(91) = 2.17, p = .03). Similarly, indicators of function and well‐being either worsened over time (for CHAQ: b = .10 ± .05, t(111) = 2.05, p = .04; for subjective well‐being: b = .67 ± .21, t(91) = 3.28, p <.01) or did not improve (for HRQOL: b = .03 ± .08, t(91) = .36, p = .72). These findings did not change when controlling for whether or not patients followed treatment recommendations. The likelihood of typical disease symptoms being reported as present (i.e., headache, sleep disruption, irritable bowel symptoms, subjective soft tissue swelling, and paresthesias) remained relatively constant over time, except for a reduced likelihood of reporting widespread pain over years since baseline (b = −.57 ± .22, t(91) = −2.53, p = .01). Treatment recommendations made by rheumatologists at baseline (e.g., physical therapy, counseling, biofeedback, medications) did not significantly change over time.Conclusion:Children with JPFS exhibit worsening pain and quality of life over time regardless of treatment modality recommendations or patient compliance to therapy. Patients returning for follow‐up visits may be those whose symptoms are most refractory. Additional studies are needed to identify barriers to improvement in this patient population and to determine effective treatment approaches to improve health outcomes.

A99: Symptom and Treatment Characteristics of Juvenile Primary Fibromyalgia Syndrome in the CARRA Registry: Are Males and Females Created Equal?

Background/Purpose:Children and adolescents with juvenile primary fibromyalgia syndrome (JPFS) often present to pediatric rheumatologists for evaluation. Limited data are available on the characteristics of and treatments used for JPFS, particularly in males.Methods:We evaluated deidentified data from baseline visits of JPFS patients entered in the Childhood Arthritis & Rheumatology Research Alliance (CARRA) registry between May 2010 and September 2013. Data regarding demographics, symptoms, functional measures and treatment are compared as a function of gender.Results:There were 172 patients (27 males), ages 8–21 years (Mean (M) = 15.4 +/− 2.3). Patients were symptomatic for a mean of 1.7 +/− 2.2 years prior to their first visit, with no significant difference between males and females (M = 2.2 vs. 1.6 respectively, t(169) = 1.19, p = .2). Widespread pain (89%), fatigue (83%), disordered sleep (77%), headaches (61%), and extremity numbness/tingling (32%) were the most commonly reported symptoms. Females had more numbness and tingling (35% vs. 13% respectively, χ2 = 4.4, p = 0.04). Table lists treatments used. Males were significantly more likely to have used gabapentin (26% vs. 8%, χ2 = 7.6, p <0.01). Of the 63 patients using non‐pharmacologic treatment, females were significantly more likely to have used massage and yoga. Over 50% of patients received education on JPFS, sleep hygiene, and general counseling. Graded aerobic activity and physical therapy were commonly prescribed. Less then 10% of patients tried opioids, serotonin norepinephrine reuptake inhibitors, craniosacral therapy, hypnosis, and biofeedback. Univariable analysis on APPLE data at baseline to 3 years Percent of Patients Treatment Females (N = 146) Males (N = 26) Pharmacological treatments tried (N = 115) Daily non‐steroidal anti‐inflammatory drugs 42% 50% Selective serotonin reuptake inhibitors 29% 15% Tri‐cyclic antidepressants 26% 25% Gabapentin 13% 35% Non‐pharmacological treatments tried (N=63) Physical therapy 60% 62% Dietary supplements 22% 46% Therapeutic massage 30% 8% Mindfulness/meditation 18% 23% Chiropractic 18% 8% Acupuncture/acupressure 16% 8% Yoga 12% 0% Significant gender difference, p<.05.Mean pain scores were moderate to severe (6.3 +/− 2.5/10) and were significantly positively related to Childhood Health Assessment Questionnaire (CHAQ) scores (r = .3, p <.01), patient ratings of impairment in health‐related quality of life (HRQOL) (r = .4, p < .01), and patient ratings of impairment in overall well‐being (r = .6, p < .01) both for males and females. Males were more disabled based on subjective (patient/parent report) functioning measures (HRQOL and CHAQ), although no differences were observed on physician report measures (physician global assessment and ACR functional class).Conclusion:Based on data from the largest known cohort of JPFS patients, there are few significant gender differences in physician assessment of disease activity. However, higher levels of disability reported by male patients suggest the need to consider gender when evaluating and treating JPFS patients. Possible explanations for the discrepancies in treatment include effects of gender on physician's perception of patient's pain leading to more medication use among males or females being more willing to try non‐pharmacologic modes of treatment. Future studies on gender and treatment outcomes are needed to improve care for these patients.

A167: Variations in Patterns of Care Across Pediatric Rheumatic Diseases in the Childhood Arthritis & Rheumatology Alliance Network Registry

Background/Purpose:In 2009, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) established a longitudinal multi‐center, multiple disease U.S. national registry (CARRA Registry) for pediatric rheumatology with the intent of providing a new framework to drive observational clinical research and best practices, evidence‐based care. Simultaneously, recognizing that widely variable therapeutic approaches hinder the ability to conduct meaningful comparative effectiveness studies and pragmatic trials in pediatric rheumatic diseases, CARRA investigators convened expert groups to formulate new consensus‐based treatment plans (CTPs) in 5 major pediatric rheumatic disease areas. As the CTP approaches are adopted, it is important to establish baseline treatment variability across pediatric rheumatic diseases and clinical sites in the CARRA network. Using longitudinal data from the CARRA Registry, we provide a first description of variability of care across the network.Methods:We examine variations of medication usage across 55 clinical sites in the treatment of 8 rheumatic conditions, including juvenile idiopathic arthritis (JIA), SLE and mixed connective tissue disease (MCTD), juvenile dermatomyositis (JDM), localized scleroderma, systemic sclerosis, juvenile primary fibromyalgia syndrome (JPFS), sarcoidosis, and vasculitis. Management of uveitis in JIA patients was also assessed. Study participants include all CARRA registry subjects enrolled in May 2010 through December 2013. Medications were categorized into 4 major classes: biologics, DMARDs, steroids and NSAIDs. We compare the percentage of patients exposed to each medication class at each; care variations were quantified using dispersion measures of standard deviation and range. A subgroup analysis was conducted to assess care variations among the largest group of subjects with similar characteristics of and low disease activity (JIA subjects with an average active joint count of 0 to 1 averaged over the enrolment period), where treatment were hypothesized to be most similar.Results:8,869 subjects were included in data analysis. Therapeutic approaches were highly variable for all 8 rheumatic diseases (Table 1, Fig 1). Subgroup analysis for JIA showed persistence of variability (Fig 2). imageConclusion:We quantify a substantial degree of therapeutic practice variability across sites, persisting across disease‐severity‐matched cohorts. Although enrollment bias is a significant limitation, the magnitude of the variability for the largest cohort (JIA) and persistence across multiple diseases and subtypes supports a widespread effect. This baseline quantification and methods developed for assessing variability will support ongoing efforts to monitor new consensus treatment protocol‐based standardization efforts across the CARRA network.

A109: Insufficient CARRA Registry Data Available to Adequately Evaluate for Associations Between Juvenile Idiopathic Arthritis, Antibody Status, and Smoke Exposure

Background/Purpose:The CARRA registry was established as a means to further investigate potential associations as well as better understand manifestations of pediatric rheumatic disease. The most frequent diagnosis in the registry is Juvenile Idiopathic Arthritis/Juvenile Ankylosing Spondylitis (JIA/JAS). An association between smoking and adult onset rheumatoid arthritis has long been established through epidemiologic studies. We hypothesized that patients with seropositive JIA, with either rheumatoid factor antibody against Fc portion of IgG or antibodies against citrullinated proteins (APCA) have higher rates of passive and/or active smoking exposure compared to patients that lack such abs including other rheumatic disease and Juvenile Primary Fibromyalgia Syndrome (JFPS).Methods:The CARRA registry was used to identify subjects with JIA/JAS, their APCA and RF status. Smoke exposure included any smoking (AS), as well as individual childhood smoking (CC) and household second hand smoke (HH). Using logistic regression smoke exposure rates were compared between subjects with and without JIA/JAS . Subjects with a diagnosis of JPFS, served as a non rheumatic disease control group. APCA and RF were compared between JIA/JAS according to smoking status and other disease populations in the registry.Results:In 2351 CARRA registry subjects for whom CC data was available, 38 smoked, resulting in an incidence of 1.6%. However, 7099 subjects had missing data (75%) regarding CC. Case control analysis did not show differences in CC in JIA compared to other pediatric rheumatic disease in the registry. Of 1512 subjects without HH, 372 (24.6%) had APCA status recorded and 691 (45.7%) had RF status recorded. Of 247 subjects with HH, 65 (26.3%) had APCA status recorded and 114 (46.2%) had RF status obtained. Interestingly there no JPFS subjects (0/605 with CC exposure. Significant risk was not found between overall smoke exposures in JIA subjects (172/1135; 15%) compared with JPFS controls (10/57; 17%). The extent to which missing data, especially with regard to HH status, contributed to the lack of demonstrable association of JIA/JAS and smoking is unknown.Conclusion:Traditional teaching in pediatric rheumatology is that measurement of RF is not useful for JIA diagnosis in children less than age ten, especially when disease is oligoarticular in onset, however consensus guidance regarding the routine measurement of APCA has not yet been established. Seropositive JIA patient numbers and those whom have had adequate ascertainment of smoking exposure are lacking in the current CARRA registry, inhibiting the analysis in this environmental epidemiology study. More complete ascertainment of smoke exposure history should be possible for those subjects remaining in the registry even though error due to recall bias may occur. There also remains an important role for initiating baseline sample collection at entry into the CARRA registry for future studies set to determine environmental/epigenetic contributions to JIA.

Relationship between Sleep and Pain in Adolescents with Juvenile Primary Fibromyalgia Syndrome

To investigate sleep quality in adolescents with juvenile primary fibromyalgia syndrome (JPFS) and determine whether sleep abnormalities, including alpha-delta sleep (ADS), correlate with pain intensity. We hypothesized that successful treatment for pain with exercise therapy would reduce ADS and improve sleep quality. Single-center preintervention and postintervention (mean = 5.7 ± 1.0 weeks; range = 4.0-7.3 weeks) observational study. Ten female adolescents (mean age = 16.2 ± 0.65 SD yr) who met criteria for JPFS and completed treatment. Multidisciplinary pain treatment, including intensive exercise therapy. Pain and disability were measured by a pain visual analog scale (VAS) and the functional disability inventory. Subjective sleep measures included a sleep VAS, an energy VAS, and the School Sleep Habits Survey. Objective sleep measures included actigraphy, polysomnography (PSG), and the Multiple Sleep Latency Test. Baseline PSG was compared with that of healthy age- and sex-matched control patients. At baseline, patients had poorer sleep efficiency, more arousals/awakenings, and more ADS (70.3% of total slow wave sleep [SWS] versus 21.9% SWS, P = 0.002) than controls. ADS was unrelated to pain, disability, or subjective sleep difficulty. After treatment, pain decreased (P = 0.000) and subjective sleep quality improved (P = 0.008). Objective sleep quality, including the amount of ADS, did not change. Although perceived sleep quality improved in adolescents with JPFS after treatment, objective measures did not. Our findings do not suggest exercise therapy for pain improves sleep by reducing ADS, nor do they support causal relationships between ADS and chronic pain or subjective sleep quality.

A pilot study of a combined intervention for management of juvenile primary fibromyalgia symptoms in adolescents in an inpatient psychiatric unit

Juvenile primary fibromyalgia syndrome (JPFS) is a chronic condition characterized by widespread musculoskeletal pain and discrete tender points with no objective evidence of a muscle disease but with disordered central pain processing. Very little is known about the prevalence and treatment on inpatient psychiatric units. The purpose of this study was to determine the effect of an intervention for JPFS in adolescent females admitted to a psychiatric hospital. In total, 30 patients with JPFS were assigned to either the intervention (n = 15) or control group (n = 15). The intervention group attended a fibromyalgia seminar followed by an audio-guided total body relaxation exercise. The control group participated in a seminar on skin care. Both groups completed a visual analog scale for affective states and somatic sensations before and after the seminar. Participants in the intervention group, but not the control group, demonstrated significant improvement in concentration, self-confidence, restfulness and comfort level (p < 0.001 to p < 0.05). They also reported a reduction in stress level, muscle tightness, stomach upset and feeling down (p < 0.001 to p < 0.05) immediately after the intervention. This study provides evidence that a combined intervention can be used in the inpatient psychiatric setting to improve functioning and overall well-being of patients with comorbid psychiatric disorders and JPFS during acute hospitalization.

Assessment of Juvenile Primary Fibromyalgia Syndrome

Juvenile primary fibromyalgia syndrome (JPFS), also known as juvenile fibromyalgia, is an idiopathic condition characterized by chronic widespread musculoskeletal pain, fatigue, and nonrestorative sleep. 1 Yunus M Masi A Juvenile primary fibromyalgia syndrome: a clinical study of thirty-three patients and matched normal controls. Arthritis Rheum. 1985; 28: 138-145 Crossref PubMed Scopus (227) Google Scholar In the pediatric population, this condition occurs predominately in adolescent females.

A pilot study: pain, fatigue and stress in maternal relatives of adolescent female psychiatric inpatients assessed for juvenile primary fibromyalgia syndrome

This study was designed to assess the presence of pain and impaired functioning in the maternal relatives of adolescent females in an inpatient adolescent psychiatric population. We compared the relatives of adolescents who met the criteria for juvenile primary fibromyalgia syndrome (JPFS) to relatives of adolescents who did not meet the criteria for JPFS. A total of 55 biological maternal relatives of adolescent females admitted to a psychiatric unit were recruited to participate in the study. Participants completed four self-administered questionnaires: Multidimensional Fatigue Inventory, Fibromyalgia Impact Questionnaire, Medical Outcomes Survey (SF36v2), and the EPIFUND Health Survey. The maternal relatives of adolescents who met the criteria for JPFS did not score higher than the maternal relatives of adolescents who did not meet the criteria for JPFS. However, all maternal relatives consistently scored higher on self-reported measures of pain, impaired functioning, fatigue, and fibromyalgia symptoms than the average patient diagnosed with fibromyalgia or a chronic pain syndrome. Mood disorders and pain disorders share genetic risk factors and vulnerability. Future research is needed to further delineate other factors impacting the maternal caregivers' functioning. These could include stress associated with an adolescent child with psychiatric issues severe enough to warrant hospitalization.

Controlled follow-up study of physical and psychosocial functioning of adolescents with juvenile primary fibromyalgia syndrome

Currently, there are no prospective studies exploring the prognosis of patients with juvenile primary FM syndrome (JPFS) or their physical, emotional and social outcomes as they enter the early adult years. The primary objective of this study was to assess long-term outcomes of a paediatric sample of clinically referred JPFS patients and their matched healthy controls. Participants were 48 youths (current mean age = 19 years) diagnosed with JPFS in childhood or adolescence and 43 healthy controls matched in age, gender and race. The average length of follow-up was 3.67 years (range 2-6 years). Participants completed online (web-based) self-report questionnaires about current pain and physical symptoms, health status, anxiety, depressive symptoms and current and past treatments. Results showed that 62.5% of participants in the JPFS group continued to experience widespread pain and 60.4% reported having all the cardinal features of FM syndrome (including widespread pain, poor sleep and fatigue) at follow-up. The JPFS group reported significantly lower scores on all measures of health status and physical functioning compared with healthy controls and significantly greater symptoms of anxiety and depression. The results of this controlled follow-up study demonstrate that symptoms of FM appear to be chronic in a majority of clinically referred JPFS patients and the associated physical and emotional impairment can also be persistent. Implications for treatment and the need for further prospective longitudinal studies are discussed.

Protective and exacerbating factors in children and adolescents with fibromyalgia.

To investigate protective and exacerbating factors in the adjustment of youth with juvenile primary fibromyalgia syndrome (JPFS), we examined the relationship of stress, coping strategies, social support, and self-efficacy to quality of life, pain, and depression. Participants were 57 youths (ages 10 to 18 years) and their parents from rheumatology clinics at 2 children's hospitals. The youths self-reported daily hassles, coping strategies, social support, self-efficacy, quality of life, pain, and depression. Parents reported on the youths' major life events and quality of life. In regression analyses, daily hassles, catastrophizing (a coping strategies scale), and self-efficacy predicted child-rated quality of life; self-efficacy predicted pain; and daily hassles predicted depression. Self-efficacy and familial social support moderated the relationship between daily hassles and depression. Daily hassles may be associated with health outcomes for youth with JPFS more than major life events are, and catastrophic thinking and self-efficacy beliefs could be appropriate intervention targets.

Actigraphy-based physical activity monitoring in adolescents with juvenile primary fibromyalgia syndrome.

Juvenile primary fibromyalgia syndrome (JPFS) is a chronic pain condition associated with significant impairment in physical functioning, but no studies have used newer technologies such as actigraphy to document objective physical activity levels in JPFS. This is the first study to objectively describe physical activity in JPFS patients and examine the relationship of pain, perceived functional impairment, and depressive symptoms on physical activity. One hundred four clinically referred adolescents with JPFS (ages 11 to 18 years) wore a hip-mounted actigraph for 1 week. Data on pain intensity, functional disability, depressive symptoms, and psychiatric diagnoses were obtained using self- and parent-report measures and a standardized psychiatric interview. Results showed that younger patients were more active. Pain intensity was not significantly associated with physical activity levels overall, but the most highly active group of adolescents reported lower levels of pain and disability than the least active. Parent report of adolescents' physical functioning and depressive symptoms were significantly correlated with adolescents' physical activity levels. Actigraphy provides a unique source of information about physical functioning which is distinct from adolescents' self-report of physical functioning in JPFS. Preliminary findings suggest that further study of factors that predict perceived and actual physical functioning in JPFS is warranted. This study presents the results of physical activity monitoring in adolescents with JPFS using actigraphy. Results indicate that actigraphy provides a unique source of objective information that can advance our understanding of physical disability in JPFS and the factors associated with physical impairment.

Relationship between School Absenteeism and Depressive Symptoms among Adolescents with Juvenile Fibromyalgia

To describe school absences in adolescents with Juvenile Primary Fibromyalgia Syndrome (JPFS) and examine the relationship between school absenteeism, pain, psychiatric symptoms, and maternal pain history. Adolescents with JPFS (N = 102; mean age 14.96 years) completed measures of pain and depressive symptoms, and completed a psychiatric interview. Parents provided information about the adolescents' school absences, type of schooling, and parental pain history. School attendance reports were obtained directly from schools. Over 12% of adolescents with JPFS were homeschooled. Those enrolled in regular school missed 2.9 days per month on average, with one-third of participants missing more than 3 days per month. Pain and maternal pain history were not related to school absenteeism. However, depressive symptoms were significantly associated with school absences. Many adolescents with JPFS experience difficulties with regular school attendance. Long-term risks associated with school absenteeism and the importance of addressing psychological factors are discussed.

The relationship between pain catastrophizing, coping efficacy and objectively measured physical activity in adolescents with Juvenile Primary Fibromyalgia Syndrome

The relationship between pain catastrophizing, coping efficacy and objectively measured physical activity in adolescents with Juvenile Primary Fibromyalgia Syndrome

Juvenile primary fibromyalgia syndrome in an inpatient adolescent psychiatric population

The purpose of this study was to identify the clinical and demographic characteristics of adolescent females admitted to a psychiatric hospital who meet the criteria for Juvenile Primary Fibromyalgia Syndrome (JPFS). Participants (n = 62) were adolescent females, ages 12 to 18 years who were admitted to an inpatient psychiatric unit. The participants completed four questionnaires: The Achenbach Youth Self-Report (YSR), the Children's Somatization Inventory (CSI), the Fibromyalgia Impact Questionnaire modified for children (FIQ-C) and the Pain Symptom Questionnaire (PSQ). Then participants were interviewed to assess the Yunus and Masi JPFS criteria. The interview included an examination of 21 (18 bilateral and 3 control) tender points. Of the 62 adolescent females enrolled, 52% (n = 32) met criteria for JPFS (i.e. JPFS cases). Both the FIQ and CSI scores were significantly elevated for JPFS cases as compared with non-cases (p = .0001 and p = .0012 respectively). Cases of JPFS also scored significantly higher on the anxiety, depression, and conduct disorder scales of the YSR. No between-group differences were found in reports of physical or sexual abuse. However, a consistently higher percentage of JPFS cases reported physical or sexual abuse as a child. Juvenile primary fibromyalgia is highly prevalent in an adolescent inpatient psychiatric unit. This possibility should be taken into consideration when chronic complaints of pain are expressed by patients in this setting, especially in those who have conduct-related issues. The connection between JPFS and abuse history requires further investigation.

Physical activity monitoring in children and adolescents with juvenile primary fibromyalgia syndrome

Juvenile primary fibromyalgia syndrome (JPFS) is a condition of chronic widespread musculoskeletal pain, and is associated with significantly impaired participation in daily physical activities. There are no studies using objective activity monitoring in JPFS to document impaired physical activity. The primary purpose of this study was to provide an objective description of daily activity levels in children and adolescents with JPFS. Specifically, to describe the percentage of time spent in sedentary, light, moderate, and vigorous activities during daytime hours.

Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome

Family factors and emotional functioning can play an important role in the ability of adolescents with juvenile primary fibromyalgia syndrome (JPFS) to cope with their condition and function in their everyday lives. The primary objectives of this study were to determine 1) whether adolescents with JPFS and their caregivers differed from healthy age-matched comparison peers and their caregivers in terms of emotional distress and functional impairment; 2) whether there were any differences in the family environment of adolescents with JPFS compared with healthy comparison peers; and 3) which individual-, caregiver-, and family-level variables were associated with functional impairment in adolescents with JPFS. Participants were 47 adolescents with JPFS recruited from a pediatric rheumatology clinic and 46 comparison peers without chronic illness matched for age, sex, and race. Participants and their caregivers (all mothers) completed a battery of standardized measures administered in their homes. Adolescents with JPFS had greater internalizing and externalizing symptoms than healthy comparison peers. Mothers of adolescents with JPFS reported twice as many pain conditions and significantly greater depressive symptoms than mothers of comparison peers. The JPFS group also had poorer overall family functioning and more conflicted family relationships. In adolescents with JPFS, maternal pain history was associated with significantly higher functional impairment. Increased distress and chronic pain are evident in families of adolescents with JPFS, and family relationships are also impacted. Implications for child functional impairment and the need for inclusion of caregivers in treatment are discussed.