eMedicine Specialties > Pediatrics: General Medicine > Rheumatology

Fibromyalgia: Follow-up

Author: Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Coauthor(s): Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing; Gregory F Keenan, MD, Director of Medical Affairs, Department of Immunology, Centocor, Inc
Contributor Information and Disclosures

Updated: Dec 10, 2008

Follow-up

Prognosis

  • Improvement in signs and symptoms of fibromyalgia syndrome (FMS) is likely in children and adolescents. In 2000, Gedalia and colleagues, after observing children in a rheumatology clinic, collected data on 50 children with an average follow-up period of 18 months.11 They found that 60% of the children had improved, 36% stayed the same, and 4% worsened compared with their initial presentation. Nearly all of the children needed to continue medications for up to 4 years after initial presentation.
  • In 1995, Buskila and colleagues studied fibromyalgia syndrome among children aged 9-15 years.22 Data on 15 of the children showed that 73% (ie, 11 of the 15) no longer met criteria for fibromyalgia syndrome at 30 months' follow-up. The mean number of tender points (TPs) and the amount of force necessary to elicit pain at each point showed significant improvement. Symptoms among the 4 children who still met criteria for fibromyalgia syndrome included abdominal pain, headache, paresthesias, morning stiffness, and sleep disturbance. Additionally, 7 children were observed who did not progress to the point of meeting the full criteria over the 30 months, and all 7 children had improved.
  • In 1998, Siegel and colleagues observed 33 patients, with a mean follow-up of 2.6 years. Improvement was observed in most patients during that follow-up time, with all patients showing some positive response to treatment.6 Given prognostic findings, children with fibromyalgia syndrome as a whole are more likely to have a favorable outcome than adults diagnosed with fibromyalgia syndrome.

Patient Education

  • Health care providers are responsible for educating children and families about every facet of fibromyalgia syndrome in an effort to improve basic knowledge and coping mechanisms to deal with the long-term aspects of the disease. All individuals involved must have fully understand the goals of treatment, including exercise regimes, expectations of medication therapy, and overriding aspects of living with chronic pain. Successful treatment and improved outcomes are enhanced when the patient has a multifaceted approach to treatment, including medical care, psychologic interventions, and physical therapy. Education concerning every aspect of care and intervention is a key to successful treatment of fibromyalgia syndrome.
  • In summary, the understanding of fibromyalgia syndrome in children is still in its infancy stage; however, strides in both diagnosis and treatment modalities have progressed in the past 10 years. Because prevalence of fibromyalgia syndrome in children is increasing, diagnosing the disorder early in its course and then recommending a multidisciplinary approach to treat the child's disorder is important. An approach that involves support for the family and specific recommendations for treatment may help decrease the symptomatology and increase the child's functioning.
  • For excellent patient education resources, visit eMedicine's Muscle Disorders Center, Mental Health and Behavior Center, and Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education articles Fibromyalgia, Chronic Fatigue Syndrome, Chronic Pain, and Fatigue.
 


More on Fibromyalgia

Overview: Fibromyalgia
Differential Diagnoses & Workup: Fibromyalgia
Treatment & Medication: Fibromyalgia
Follow-up: Fibromyalgia
Multimedia: Fibromyalgia
References
[ CLOSE WINDOW ]

References

  1. Anthony KK, Schanberg LE. Juvenile primary fibromyalgia syndrome. Curr Rheumatol Rep. Apr 2001;3(2):165-71. [Medline].

  2. Bennett RM. The fibromyalgia syndrome. In: Textbook of Rheumatology. 5th ed. Philadelphia, PA: WB Saunders Co; 1997:511-9.

  3. Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum. Feb 1985;28(2):138-45. [Medline].

  4. Yunus MB. Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Semin Arthritis Rheum. Jun 2008;37(6):339-52. [Medline].

  5. Yunus MB. Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Semin Arthritis Rheum. Jun 2007;36(6):339-56. [Medline].

  6. Siegel DM, Janeway D, Baum J. Fibromyalgia syndrome in children and adolescents: clinical features at presentation and status at follow-up. Pediatrics. Mar 1998;101(3 Pt 1):377-82. [Medline].

  7. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum. Jan 1995;38(1):19-28. [Medline].

  8. Romano TJ. Fibromyalgia in children; diagnosis and treatment. W V Med J. Mar 1991;87(3):112-4. [Medline].

  9. Buskila D, Press J, Gedalia A. Assessment of nonarticular tenderness and prevalence of fibromyalgia in children. J Rheumatol. Feb 1993;20(2):368-70. [Medline].

  10. Kashikar-Zuck S, Graham TB, Huenefeld MD, Powers SW. A review of biobehavioral research in juvenile primary fibromyalgia syndrome. Arthritis Care Res. Dec 2000;13(6):388-97. [Medline].

  11. Gedalia A, Garcia CO, Molina JF; Bradford NJ; Espinoza LR. Fibromyalgia syndrome: experience in a pediatric rheumatology clinic. Clin Exp Rheumatol. May-Jun 2000;18(3):415-9. [Medline].

  12. Tayag-Kier CE, Keenan GF, Scalzi LV. Sleep and periodic limb movement in sleep in juvenile fibromyalgia. Pediatrics. Nov 2000;106(5):E70. [Medline].

  13. Conte PM, Walco GA, Kimura Y. Temperament and stress response in children with juvenile primary fibromyalgia syndrome. Arthritis Rheum. Oct 2003;48(10):2923-30. [Medline].

  14. Neumann L, Smythe HA, Buskila D. Performance of point count and dolorimetry in assessing nonarticular tenderness in children. Arthritis and Rheumatism. 1989;28(2):138-145.

  15. Calabro JJ. Fibromyalgia (fibrositis) in children. Am J Med. Sep 29 1986;81(3A):57-9. [Medline].

  16. Degotardi PJ, Klass ES, Rosenberg BS, et al. Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia. J Pediatr Psychol. Aug 2006;31(7):714-23. [Medline].

  17. Walco GA, Ilowite NT. Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. J Rheumatol. Oct 1992;19(10):1617-9. [Medline].

  18. Kashikar-Zuck S, Vaught MH, Goldschneider KR, et al. Depression, coping, and functional disability in juvenile primary fibromyalgia syndrome. J Pain. Oct 2002;3(5):412-9. [Medline].

  19. Rossy LA, Buckelew SP, Dorr N, et al. A meta-analysis of fibromyalgia treatment interventions. Ann Behav Med. Spring 1999;21(2):180-91. [Medline].

  20. Goldenberg D, Mayskiy M, Mossey C, Ruthazer R, Schmid C. A randomized, double-blind crossover trial of fluoxetine and amitriptyline in the treatment of fibromyalgia. Arthritis Rheum. Nov 1996;39(11):1852-9. [Medline].

  21. Arnold LM, Russell IJ, Diri EW, et al. A 14-week, randomized, double-blinded, placebo-controlled monotherapy trial of pregabalin in patients with fibromyalgia. J Pain. Sep 2008;9(9):792-805. [Medline].

  22. Buskila D, Neumann L, Hershman E. Fibromyalgia syndrome in children--an outcome study. J Rheumatol. Mar 1995;22(3):525-8. [Medline].

  23. Bassan H, Niv D, Jourgenson U. Localized fibromyalgia in a child. Paediatr Anaesth. 1995;5(4):263-5. [Medline].

  24. Bradley LA, Alarcon GS. Fibromyalgia. In: Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore, MD: Williams & Wilkins; 1996:1619-40.

  25. Breau LM, McGrath PJ, Ju LH. Review of juvenile primary fibromyalgia and chronic fatigue syndrome. J Dev Behav Pediatr. Aug 1999;20(4):278-88. [Medline].

  26. Buskila D. Fibromyalgia in children--lessons from assessing nonarticular tenderness. J Rheumatol. Dec 1996;23(12):2017-9. [Medline].

  27. Buskila D. Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome. Curr Opin Rheumatol. Mar 2001;13(2):117-27. [Medline].

  28. Cassidy JT, Petty RE. Musculoskeletal pain syndromes of nonrheumatic origin. In: Textbook of Pediatric Rheumatology. 3rd ed. Philadelphia, PA: WB Saunders; 1995:108-32.

  29. Harding SM. Sleep in firbomyalgia patients: subjective and objective findings. American Journal of Medical Science. 1998;26:315. [Medline].

  30. Millea PJ, Holloway RL. Treating fibromyalgia. Am Fam Physician. Oct 1 2000;62(7):1575-82, 1587. [Medline].

  31. Moldofsky H. Sleep and fibrositis syndrome. Rheum Dis Clin North Am. Feb 1989;15(1):91-103. [Medline].

  32. Pellegrino MJ, Waylonis GW, Sommer A. Familial occurrence of primary fibromyalgia. Arch Phys Med Rehabil. Jan 1989;70(1):61-3. [Medline].

  33. Pillemer SR, Bradley LA, Crofford LJ, et al. The neuroscience and endocrinology of fibromyalgia. Arthritis Rheum. Nov 1997;40(11):1928-39. [Medline].

  34. Reid GJ, Lang BA, McGrath PJ. Primary juvenile fibromyalgia: psychological adjustment, family functioning, coping, and functional disability. Arthritis Rheum. Apr 1997;40(4):752-60. [Medline].

  35. Roizenblatt S, Tufik S, Goldenberg J. Juvenile fibromyalgia: clinical and polysomnographic aspects. J Rheumatol. Mar 1997;24(3):579-85. [Medline].

  36. Sigal LH, Patella SJ. Lyme arthritis as the incorrect diagnosis in pediatric and adolescent fibromyalgia. Pediatrics. Oct 1992;90(4):523-8. [Medline].

  37. Wolfe F, Smythe HA, Yunus MB. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. Feb 1990;33(2):160-72. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

fibromyalgia, fibrositis, myofascial syndrome, nonarticular rheumatism, soft tissue rheumatism, fibromyalgia syndrome, FMS, juvenile primary fibromyalgia syndrome, juvenile FMS, pediatric fibromyalgia syndrome, pediatric FMS, juvenile primary FMS, juvenile primary fibromyalgia syndrome, JPFS, anxiety, stress, weather changes, irritable bowel symptoms, poor memory, tension headaches, dizziness, fluid retention, paraesthesias, restless legs, bruising, Raynaud phenomenon, sleep disturbance, central sensitivity syndromes, CSS, juvenile chronic arthritis, periodic limb movement in sleep, PLMS, migraines, restless leg syndrome, joint edema, temporomandibular disorders, myofascial pain syndrome, female urethral syndrome, interstitial cystitis, multiple chemical sensitivity syndrome, posttraumatic stress disorder

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Coauthor(s)

Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC, Associate Professor of Nursing, Department of Acute and Continuing Care, University of Texas Health Sciences Center Houston School of Nursing
Eileen R Giardino, PhD, RN, MSN, FNP-BC, ANP-BC is a member of the following medical societies: American Academy of Nurse Practitioners, American College Health Association, American Nurses Association, American Professional Society on the Abuse of Children, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Gregory F Keenan, MD, Director of Medical Affairs, Department of Immunology, Centocor, Inc
Gregory F Keenan, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Rheumatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Lawrence K Jung, MD, Chief, Division of Pediatric Rheumatology, Children's National Medical Center
Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.