Fibromyalgia in children and adolescents: Treatment and prognosis
- Yukiko Kimura, MD
Yukiko Kimura, MD
- Professor of Pediatrics
- Rutgers University - New Jersey Medical School
- Division Chief of Pediatric Rheumatology
- Joseph M Sanzari Children's Hospital
- Hackensack University Medical Center
- Gary A Walco, PhD
Gary A Walco, PhD
- Professor of Anesthesiology and Pain Medicine; Adjunct Professor of Pediatrics and Psychiatry
- University of Washington School of Medicine
Fibromyalgia is one of a number of chronic pain disorders that is characterized by central sensitization underlying pervasive chronic pain [1,2]. However, the specific etiologic and pathogenic elements of this disorder are not fully understood. Fibromyalgia is characterized by chronic and diffuse musculoskeletal pain, severe fatigue, and nonrestorative sleep. Initially described in adults, this disorder was subsequently described in children and adolescents and is often referred to as juvenile primary fibromyalgia [3-6]. (See "Pathogenesis of fibromyalgia".)
A multidisciplinary approach that incorporates clinicians, psychologists, and rehabilitation specialists and that offers a combination of pharmacologic, cognitive-behavioral, and physical interventions, along with patient education, is most effective in treating patients with fibromyalgia. A stepwise approach to management is taken, starting with psychologic and physical interventions. Medications may be added, particularly for treating certain aspects of fibromyalgia such as depression and anxiety, sleep disturbances, and pain.
The treatment of fibromyalgia in children and adolescents is reviewed here. The clinical manifestations and diagnosis of fibromyalgia in children and the clinical features, diagnosis, and treatment of the disease in adults are presented separately. (See "Fibromyalgia in children and adolescents: Clinical manifestations and diagnosis" and "Clinical manifestations and diagnosis of fibromyalgia in adults" and "Initial treatment of fibromyalgia in adults".)
Well-controlled clinical trials indicate that cognitive-behavioral therapy (CBT) is effective in reducing functional disability and symptoms of depression in adolescents with juvenile primary fibromyalgia syndrome . Critical elements of treatment include physical exercise  and cognitive-behavioral strategies to enhance coping and self-regulation of pain .
In our practice, management of a child with fibromyalgia includes the following:
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