Juvenile Fibro and Anxiety

A recent article has suggested that children with Fibromyalgia Syndrome (Fibro) are more likely to suffer from anxiety disorders, and that anxiety is linked to poorer functioning in these patients. [1]

The article, from a group of researchers in the Division of Behavioral Medicine and Clinical Psychology at the University of Cincinnati College of Medicine, Ohio, USA, was published in the September issue of The Clinical Journal of Pain.

Their study aimed to assess the prevalence of mood, anxiety, and behavioral disorders in children and adolescents with juvenile primary fibromyalgia syndrome (JPFS) and to assess the relationship between psychiatric disorders and the severity of their Fibro. [1]

The study looked at 76 children and adolescents diagnosed with JPFS (ages 11 to 18 years) in pediatric rheumatology clinics at 4 hospitals in the Midwest area of the USA. Standardized psychiatric interviews were conducted with the children/adolescents and their parents or primary caregivers, and measures of symptom severity, including pain intensity and physician global ratings, were obtained for the patients. [1]

The researchers found that 67.1% of the patients had at least 1 current psychiatric diagnosis and 71.5% had at least 1 lifetime psychiatric diagnosis, with the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-fourth edition) being used to define psychiatric diagnoses. [1]

The most frequent psychiatric diagnosis was anxiety disorder (57.5% of patients). [1]

Although mood difficulties were also common, the researchers found that the presence of major depression in the young participants was lower than has been reported for adults with Fibro. [1]

Physicians' global assessment of functioning was significantly lower for patients with a current anxiety disorder. However, it was found that there were no significant differences in pain severity among patients with and without anxiety, mood, or behavioral disorders. [1]

The researchers 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."

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. [2]

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. [2][3]

Although there is an emerging understanding of JPFS and its treatment, [2] 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, 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.
2. Baldursdóttir S. [Juvenile primary fibromyalgia syndrome--review] Laeknabladid. 2008 Jun;94(6):463-72.
3. 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.