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Children with Juvenile Fibromyalgia Syndrome May Experience Anxiety Disorders
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Posted on: 09/18/2008
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Fibromyalgia, an autoimmune disease, is one that usually affects adults. However, there is a fibromyalgia syndrome that affects children, called Juvenile Fibromyalgia Syndrome. Like adult fibromyalgia, the syndrome causes general pain and tender points throughout the body, fatigue, difficulty sleeping, irritable bowel syndrome, and other problems. While fibromyalgia affects mostly women, juvenile fibromyalgia also affects mostly girls, although it can affect boys. It usually strikes children in the mid-teen years, from 13 to 15 years old.
Juvenile fibromyalgia is as puzzling to researchers and doctors as is the adult type. As well, doctors don't know how children with the syndrome will end up, although some research says that the majority of affected teens (80 to 90 percent) continue to have symptoms two to three years after follow-up. Doctors have also found that many teens with fibromyalgia also have emotional or psychological problems that can play a role on how the syndrome progresses.
Although research has found that depression and anxiety can be found in adults with fibromyalgia, this research hasn't been done in children. Up 24 to 34 percent of adults with fibromyalgia appear to have these difficulties, although this may be higher as not everyone with fibromyalgia who experiences depression or anxiety seeks medical help.
The authors of this article wanted to find out how many children with juvenile fibromyalgia experienced anxiety and/or depression during their illness and throughout their lifetime. To do this, researchers recruited 76 children, aged from 11 to 18 years, who had juvenile fibromyalgia. To qualify for the study, the children must have had general pain in three or more places for three or more months, with no explained cause. Or, they could have severe pain in at least five tender points and at least three other symptoms, such as irritable bowel, headache, sleep difficulties, and fatigue.
The patients were sent information on how to complete a pain diary one week before their first visit, when they turned in the diary. At the visit, the patients completed an interview using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). This method is used to assess psychiatric issues. The researchers also obtained information on any medications used and pain intensity ratings on a visual assessment scale (VAS) of 0 to 10, with 0 being no pain and 10 being the worst pain ever. A rheumatologist also assessed the patients were doing. This, too, was on a scale of 0 to 10, ranging from "doing very poorly" to "doing very well."
When gathering the data, the researchers found that the children's VAS rating on pain in their pain diary was an average of 5.27 (out of 10). Seventy-three patients completed the K-SADS-PL and 49 had at least one current psychiatric diagnosis at that time and 72 had one over their lifetime. The most common diagnosis was anxiety disorder (phobias, anxiety and panic). Twenty-two patients had two diagnosis at the same time. Sixteen patients were diagnosed with mood disorders at the current time and 30 over their lifetime. Six patients had major depressive disorder. Attention deficit problems were found in 19 patients. Put into percentages, children with fibromyalgia syndrome had a 67.1 percent chance of having a psychiatric diagnosis at least once and a 71.2 percent chance in their lifetime. In the general population, there is a 36.7 percent chance of children and teens having a psychiatric problem.
Many of the children were taking medications most often the older antidepressant medication, amitriptyline and/or pain relievers from the nonsteroidal anti-inflammatory drugs (NSAIDs) group. Some other types of antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and medications for seizures were given to a few children.
The authors wrote that the findings weren't surprising as they had found earlier that children with juvenile fibromyalgia tended to have more anxiety than children who didn't have it. They found that teens with the disorder "were perceived as more sensitive and isolated than their peers." The study outcome is important in helping doctors understand treatment of juvenile fibromyalgia and that anxiety orders are often part and parcel of the problem. The authors also point out that their finding of attention deficit disorder was a new finding so more research is needed along those lines.
As with all studies, this one had limitations. For example, the children in the sample weren't representative of the general public as they had all been referred for care and the sample size itself was small, making it harder to draw general conclusions. However, despite these drawbacks, the researchers believe that the study findings are a good start in helping understand the psychological issues associated with juvenile fibromyalgia.
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References:
Susmita Kashikar-Zuck, PhD, et al. Anxiety, Mood, and Behavioral Disorders Among Pediatric Patients with Juvenile Fibromyalgia Syndrome. In The Clinical Journal of Pain. September 2008. Vol. 24. No. 7. Pp. 620-626.
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