Fibromyalgia in Children

Juvenile Fibromyalgia

Fibromyalgia in children, defined as juvenile fibromyalgia, is a condition that begins before the age of 18 and affects children and teenagers who have fibromyalgia symptoms. Fibromyalgia in children is a significant health problem because it can negatively affect children's physical and emotional health. They may be deprived of their school and social life and even restrict their physical activities, causing increased anxiety and having a negative impact on the child's normal development.

Is Fibromyalgia Common in Children?

Children and adolescents with juvenile fibromyalgia constitute a very high rate of 7% to 15% of those admitted to pediatric outpatient clinics. Juvenile fibromyalgia, or chronic widespread pain, affects up to 6% of children and adolescents, according to another study. Female adolescents are affected 4 times more than males. The age of first diagnosis is typically between 13 and 15 years old.

How is Fibromyalgia Diagnosed in Children?

Estimations of incidence rate of fibromyalgia in children are an overall approach. Because of children may have difficulties in expressing and explaining pain symptoms therefore, diagnosis is difficult. Children can often have difficulty accurately describing their pain or discomfort. For this reason, the actual incidence of fibromyalgia in children is thought to be higher than reported rates. This may cause the correct diagnosis and reported cases to remain below the real number.
Diagnosing fibromyalgia in children is also difficult due to some diseases that can mimic fibromyalgia or have similar symptoms. These children often have a family history of chronic pain. Physical examination and laboratory findings do not reveal clear abnormalities  and this situation is making it difficult to explain the diagnosis to patients and families. Therefore, patients may have been seen by multiple specialists until they reached the right specialist, resulting in unnecessary testing and costs in the hope that a definitive medical diagnosis could be found. This adds to the confusion of patients and families.

What are the symptoms of fibromyalgia in children?

Growing pains, especially in children, can be similar to fibromyalgia symptoms. Therefore, growing pains may cause a diagnosis of fibromyalgia to be missed. Apart from this, chronic fatigue syndrome, hypermobility, rheumatic diseases such as juvenile rheumatoid arthritis, stress and psychological factors can cause widespread pain, fatigue, lack of energy, swelling in the joints, headache and abdominal pain in children, which can be confused with fibromyalgia. Therefore, a detailed evaluation is required to take these diseases into account and exclude them. For this reason, family support - pediatrician - physical therapist cooperation is very important so that the child can express his symptoms correctly and communicate with the doctor.
Numbness and tingling symptoms are more common in girls; It has been reported that symptoms such as sleep difficulties, headaches and irritable bowels are seen at similar rates among both girls and boys. Boys diagnosed with juvenile fibromyalgia experience significantly more functional impairment and worse health-related quality of life compared to girls.

How Is Juvenile Fibromyalgia Treated?

Studies showing the beneficial effects of cognitive behavioral therapy, physical exercise, and combined treatments for juvenile fibromyalgia recommend multidisciplinary treatment. It is thought that the worsening functions of juvenile fibromyalgia patients over time may be due to poorly controlled mood symptoms rather than worsening increasing pain, which reveals the importance of early recognition and multidisciplinary management of the disease. Studies also show that, instead of offering a single recommendation for drug treatments, early multidisciplinary pain management provides an overall improvement in the child's return to daily activities and functionality.
It is recommended to inform and educate the child and family about the disease, to start the necessary drug treatments, to improve the child's sleep hygiene, to increase physical activity with low-impact exercise such as graded aerobic exercise program and water therapy. It is also important to increase physical activity and continue normal school and daily activities. For the child's sleep hygiene; Having consistent bedtime and wake-up times, sleeping in a cool, comfortable and dark room without electronics, and recommending trying a quiet activity such as reading a book or something else are important to improve sleep quality. Children who cannot fall asleep within 30 minutes should stop screen-related activities before sleep. Psychological therapies such as physical therapy and Cognitive Behavioral Therapy, as well as the use of acupuncture, massage and other complementary treatments are also very useful.

Fibromyalgia in Children Should Be Treated to Prevent Pain Permanently

In order to manage the severe pain of children and adolescents with chronic pain, families should not ignore their children's pain and should consult a physician as soon as possible. Chronic painful conditions, especially seen at a young age, may create the possibility of reducing pain sensitivity due to the neuroplasticity of the nervous system (the ability of the brain to adapt to structural or physiological changes) that develops with growth. It is of great importance to intervene with early treatment in these children to prevent the pain from remaining permanent