Pain distribution less indicative of impairment than other factors in juvenile fibromyalgia
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In patients with juvenile fibromyalgia, pain distribution throughout the body may be less important for clinical outcomes and impairment than other factors, according to data published in Arthritis Care & Research.
“Juvenile fibromyalgia (JFM) affects approximately 2-6% of children and adolescents, primarily females,” Anne M. Lynch-Jordan, PhD, of the department of pediatrics at the University of Cincinnati College of Medicine, and colleagues wrote. “However, the true prevalence remains unknown because of the inconsistency in the conceptualization and classification of JFM, limiting advances in understanding this disabling condition.
“There has been little effort to comprehensively phenotype JFM symptom characteristics in a representative pediatric population,” they added.
To examine pain and associated symptoms among a large cohort of patients with juvenile fibromyalgia, Lynch-Jordan and colleagues analyzed data collected as part of a larger controlled trial of the disease in teenagers. Included patients were adolescents who previously completed baseline assessments for the aforementioned trial between January 2018 and April 2021.
Participants were required to be diagnosed with juvenile fibromyalgia by a pediatric rheumatologist or pain physician, demonstrate moderate levels of functional disability, have an average pain intensity score of 4 or more on a 0 to 10 cm visual analog scale, and be on stable treatment for 2 to 4 weeks prior to enrollment. Meanwhile, patients were excluded if they demonstrated underlying rheumatic diseases or untreated psychiatric illnesses.
As part of the assessments, patients reported their age, gender identity, race and ethnic identities. In addition, patients were assessed for fibromyalgia pain and symptom severity, pain intensity, fatigue and joint hypermobility. Patients were also assessed regarding the impact of their pain on their ability to function and their depressive and anxiety-related symptoms.
The analysis included 203 patients aged 12 to 17 years. The median number of painful body sites was 11 and the average symptom severity score was 9. In general, the most prominent disease features were fatigue and nonrestorative sleep, which were both rated as moderate-to-severe by 85% of included patients. Patients also commonly reported impact from neurologic, autonomic, gastroenterological and psychological symptoms.
According to the researchers, spatial spread of pain across body sites, as measured by the Widespread Pain Index, was significantly correlated with pain intensity and catastrophizing. Meanwhile, somatic symptom scores were associated with pain intensity and all domains of physical and psychological functioning, the researchers wrote. Additionally, depressive symptoms, fatigue and pain catastrophizing were all predictors of pain impairment severity.
“Based on the current study, JFM syndrome seems closely aligned with the adult manifestation of FM — with widespread pain, fatigue, sleep difficulties and autonomic dysregulation being hallmark characteristics of JFM in adolescence,” Lynch-Jordan and colleagues wrote. “With further validation, the [Pain and Symptom Assessment Tool] measure could be a valuable JFM screening tool to quantify widespread pain and symptom severity, thereby advancing the field’s ability to systematically identify, track and describe the natural course of JFM, and evaluate response to treatment.”
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