Family factors in children with Fibromyalgia Syndrome

According to a recent article, families of adolescents with juvenile primary fibromyalgia syndrome have greater health problems themselves and family relationships are affected. This in turn then has an effect on the health of the adolescents with juvenile primary fibromyalgia syndrome. [1]

Family factors and emotional functioning can play an important role in the ability of adolescents with juvenile primary fibromyalgia syndrome (JPFS) to cope with their condition and function in their everyday lives. [1]

The primary objectives of the study, carried out by a team of researchers at Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Ohio, USA, were to determine:

1. whether adolescents with juvenile primary fibromyalgia syndrome and their caregivers differed from healthy age-matched comparison peers and their caregivers in terms of emotional distress and functional impairment;
2. whether there were any differences in the family environment of adolescents with juvenile primary fibromyalgia syndrome compared with healthy comparison peers;
3. which individual-, caregiver-, and family-level variables were associated with functional impairment in adolescents with juvenile primary fibromyalgia syndrome.

The study compared 47 adolescents with juvenile primary fibromyalgia syndrome recruited from a pediatric rheumatology clinic and 46 healthy peers matched for age, sex, and race. The study participants and their caregivers (all mothers) completed a battery of standardized measures administered in their homes.

The researchers found that adolescents with juvenile primary fibromyalgia syndrome had greater internalizing and externalizing symptoms than healthy comparison peers. Mothers of adolescents with juvenile primary fibromyalgia syndrome reported twice as many pain conditions and significantly greater depressive symptoms than mothers of comparison peers. The juvenile primary fibromyalgia syndrome group also had poorer overall family functioning and more conflicted family relationships. In adolescents with juvenile primary fibromyalgia syndrome, maternal pain history was associated with significantly higher functional impairment. [1]

The researchers concluded that:

"Increased distress and chronic pain are evident in families of adolescents with JPFS, and family relationships are also impacted. Implications for child functional impairment and the need for inclusion of caregivers in treatment are discussed." [1]

This comes after a related team of researchers at University of Cincinnati College of Medicine, Ohio, USA, published an article in the September issue of The Clinical Journal of Pain in which they concluded that:

"There seems to be a high prevalence of anxiety disorders in patients with JPFS, and presence of anxiety disorder is associated with poorer physician-rated functioning. Future research should explore whether early anxiety symptoms are predictive of long-term functioning." [2]

According to an article published in an Icelandic journal earlier this year, the estimated prevalence of juvenile primary fibromyalgia syndrome (JPFS) is 1.2%-6.2%, with prevalence being higher in girls than in boys, and peaking at the time of puberty. The development of JPFS is related to many factors, such as genetic and anatomic factors, disordered sleep and psychological distress. [3]

The diagnosis of JPFS is based on the criteria defined by Yunus and Masi in 1985, which include generalised musculoskeletal aching at three or more regions for at least three months and at least five of eighteen typical tender points. [3][4]

Although there is an emerging understanding of JPFS and its treatment, [3] the situation in the UK hasn't improved much since 1985, when Masi and Yunus (the now legendary Fibro expert, Dr. Muhammad B. Yunus), wrote that:

"Juvenile PFS is often misdiagnosed. Recognition of this common rheumatologic condition in juveniles is important in order to avoid unwarranted investigations and improper management."

References:

1. Kashikar-Zuck S, Lynch AM, Slater S, Graham TB, Swain NF, Noll RB. Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome. Arthritis Rheum. 2008 Sep 29;59(10):1392-1398. [Epub ahead of print]
2. Kashikar-Zuck S, Parkins IS, Graham TB, Lynch AM, Passo M, Johnston M, Schikler KN, Hashkes PJ, Banez G, Richards MM. Anxiety, mood, and behavioral disorders among pediatric patients with juvenile fibromyalgia syndrome. Clin J Pain. 2008 Sep;24(7):620-6.
3. Baldursdóttir S. [Juvenile primary fibromyalgia syndrome--review] Laeknabladid. 2008 Jun;94(6):463-72.
4. Yunus MB, Masi AT. Juvenile primary fibromyalgia syndrome. A clinical study of thirty-three patients and matched normal controls. Arthritis Rheum. 1985 Feb;28(2):138-45.