Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.
Fibromyalgia is commonly thought of as a condition that affects adults. However, fibromyalgia also occurs in children and adolescents. Estimates suggest that juvenile-onset fibromyalgia affects 2 to 6 percent of school children, mostly adolescent girls. It is most commonly diagnosed between ages 13 and 15.
Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.
In children with fibromyalgia, symptoms include:
- Widespread diffuse pain. The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
- Headache. Frequent headaches occur in a majority of patients with fibromyalgia.
- Sleep disturbances. Despite complaints of severe fatigue, these children often take an hour or more to fall asleep. Even when they do fall asleep, many have difficulty maintaining sleep and wake up during the night.
- Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.
- Other problems. Many people who have fibromyalgia also may have pain or cramping in the lower abdomen, report cognitive impairment (described as feeling in a "fog"), and experience depression and anxiety.
Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:
- Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
- Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
- Physical or emotional trauma. Post-traumatic stress disorder has been linked to fibromyalgia.
Why does it hurt?
Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.
Risk factors for fibromyalgia include:
- Your sex. Fibromyalgia is diagnosed more often in girls and women.
- Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
- Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.
The pain and lack of sleep associated with fibromyalgia can interfere with the ability to function at school or at home. The frustration of dealing with an often-misunderstood condition also can result in depression and anxiety.
Because many of the signs and symptoms of fibromyalgia are similar to other disorders, you may see several doctors before receiving a diagnosis. Your family physician may refer you to a doctor who specializes in the treatment of arthritis and other inflammatory conditions (rheumatologist).
What you can do
Before your appointment, you may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you've had in the past
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
In addition to a physical exam, your doctor will probably ask you if you have problems sleeping and if you've been feeling depressed or anxious.
The diagnosis of juvenile fibromyalgia is made clinically and is based on a history of chronic, generalized pain and associated features (fatigue, sleep disturbances, headache and depression), a physical examination that demonstrates the presence of tender points and excludes other diagnoses, and negative or normal laboratory tests.
Although the American College of Rheumatology criteria for fibromyalgia weren't written specifically for children, they are sometimes used for children and adolescents.
The Yunus and Masi criteria, on the other hand, are specifically for juvenile fibromyalgia. The diagnosis is based on the presence of all of the major criteria plus three of the 10 minor criteria:
- Generalized musculoskeletal aching at three or more sites for at least three months
- Absence of an underlying condition or cause (for example, arthritis or trauma)
- Normal test results
- Five tender points
- Chronic anxiety or tension
- Poor sleep
- Chronic headaches
- Irritable bowel syndrome
- Subjective soft tissue swelling
- Pain modulation of physical activity
- Pain modulation by weather factors
- Pain modulation by anxiety and stress
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions, such as juvenile arthritis, that may have similar symptoms. Blood tests may include:
- Complete blood count
- Erythrocyte sedimentation rate
- Thyroid function tests
A multidisciplinary approach that incorporates clinicians, psychologists and rehabilitation specialists and that offers a combination of pharmacological, cognitive behavioral and physical interventions, along with patient education, has been shown to be most effective in treating children and teens with fibromyalgia.
Medications can help reduce the pain of fibromyalgia and improve sleep. Data on the use of medications in the treatment of juvenile fibromyalgia are limited. However, agents that have shown benefit in adults also have been used in children, and are sometimes effective. Common choices include:
- Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Other antidepressants, such as amitriptyline and fluoxetine (Prozac), are sometimes prescribed and appear to help promote sleep.
- Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Pain reliever such as tramadol (Ultram, Conzip) are also sometimes prescribed. Use of opioids and narcotics should be avoided in treating juvenile fibromyalgia.
- Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are sometimes prescribed for adults to reduce fibromyalgia symptoms.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is an intervention that has been well-studied in the treatment of chronic pain in children, and has been found to help reduce disability and depression. CBT focuses on helping people with fibromyalgia manage their pain using adaptive coping skills. These include the use of relaxation-based treatments, distraction, activity pacing, scheduling pleasant activities, problem-solving, and replacing negative and catastrophic thoughts with more calming and realistic appraisals.
For children and adolescents with fibromyalgia, parents usually participate in some CBT sessions to learn how to coach and support their children's use of these coping skills at home.
Self-care is critical in the management of fibromyalgia:
- Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
- Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
- Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
- Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
- Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. Indeed, today some alternative therapies have gained acceptance in mainstream medicine.
The following practices appear to safely relieve stress and reduce pain, thereby helping people with fibromyalgia manage their symptoms:
- Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
- Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.
April 29, 2014
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