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Oh A, Koehler A, Yonker M, Troester M. Sleep Disorders and Chronic Pain Syndromes in the Pediatric Population. Semin Pediatr Neurol 2023; 48:101085. [PMID: 38065632 DOI: 10.1016/j.spen.2023.101085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/18/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023]
Abstract
Sleep problems are widespread in children and adolescents suffering from chronic pain disorders. Sleep loss intensifies the experience of pain and is detrimental to the budding self-efficacy of a young individual with limitless horizons. Addressing sleep disorders may prevent the chronification of pain and prevent adverse health outcomes, such as functional impairment, psychiatric comorbidities and overall poor quality of life. This review will explore the cyclical nature between sleep, pain and mood, as well as the functional impact of this relationship on children and adolescents. There will be a discussion about sleep assessment and diagnostic testing, followed by a description of sleep disturbances found in specific pain conditions, ranging from headache, musculoskeletal/abdominal pain, to rheumatologic disorders. Finally, there will be a brief review of pharmacologic and behavioral interventions designed to improve sleep quality, and when possible, to alleviate pain.
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Affiliation(s)
- Ann Oh
- Division of Neurology, UCSF Pediatric Headache Center, University of California, San Francisco, UCSF Benioff Children's Hospital, Mission Hall, 550 16th Street, 5th Floor, San Francisco, CA 94158, USA.
| | - Angelina Koehler
- Division of Neurology, Pediatric Headache Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Marcy Yonker
- Division of Neurology, Pediatric Headache Program, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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2
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Gmuca S, Weiss PF, McGill M, Xiao R, Ward M, Nelson M, Sherry DD, Cronholm PF, Gerber JS, Palermo TM, Young JF, Rosenberg AR. The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial. CHILDREN 2022; 9:children9101432. [PMID: 36291374 PMCID: PMC9600525 DOI: 10.3390/children9101432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s impact on clinical outcomes among youth with chronic musculoskeletal pain (CMP). This was a single-arm pilot trial of PRISM for youth with CMP aged 12–17 years. Patients completed patient-reported outcome measures (PROs) pre- and post- intervention; patients and caregivers provided qualitative feedback. Twenty-seven patients were enrolled (63% enrollment rate); 82% percent were female. The patients’ median age was 16 years (IQR: 13–16). The intervention completion rate was 81% (n = 22). The mean satisfaction for PRISM overall was 4.3 (SD 0.9), while the mean acceptability of the intervention measure (AIM) was 4.4 (SD 0.89). Participants reported improved resilience (2.2 [SD 5.1]), functional disability (−3.5 [IQR: −6.0, 1.0]), and psychological distress (−1.0 [−5.0, 2.0]) from baseline to immediately post-treatment; pain intensity, pain catastrophizing, and global health were similar at both time points. Feedback was positive and suggested that a group component may be helpful. PRISM is feasible and acceptable among youth with CMP. Exploratory analyses suggest improvements in clinically relevant outcomes, warranting further investigation.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Correspondence: ; Tel.: +1-(718)-614-5251 or +1-(215)-590-2547; Fax: +1-(215)-590-4750
| | - Pamela F. Weiss
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mackenzie McGill
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Rui Xiao
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michaela Ward
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Maria Nelson
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David D. Sherry
- Department of Pediatrics, Division of Rheumatology, Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 11-121, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Peter F. Cronholm
- Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Family Medicine and Community Health, Center for Public Health Initiatives, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Gerber
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Jami F. Young
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Department of Child and Adolescent Psychiatry and Behavioral Services, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Abby R. Rosenberg
- Palliative Care and Resilience Program, Seattle Children’s Research Institute, Seattle, WA 98145, USA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA 98104, USA
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA 98195, USA
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Metyas S, Chen C, Joseph M, Hanna N, Basta J, Khalil A. Subcategories of Fibromyalgia: A New Concept. Curr Rheumatol Rev 2022; 18:18-25. [PMID: 35220935 DOI: 10.2174/2666255815666220225103234] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023]
Abstract
Fibromyalgia has previously been categorized as primary, secondary, and juvenile fibromyalgia. However, these definitions do not adequately explain the etiopathology of disease, nor do they help direct new specific therapies. Herein, we review the previously known categorizations of fibromyalgia. Based on common patient characteristics and previously studied pathophysiologies, we propose new subcategorizations of fibromyalgia that we have self-narrated, including hormonal fibromyalgia, neuroendocrine fibromyalgia, psychologic fibromyalgia, inflammatory fibromyalgia, and lastly, neuropathic fibromyalgia. Future research needs to be done to verify, add to, and fully describe these self-narrated categories of fibromyalgia that we have proposed.
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Affiliation(s)
- Samy Metyas
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Marina Joseph
- Covina Arthritis Clinic, Covina, California, CA, USA
| | | | - Joseph Basta
- Covina Arthritis Clinic, Covina, California, CA, USA
| | - Andrew Khalil
- Covina Arthritis Clinic, Covina, California, CA, USA
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VOSviewer-Based Bibliometric Network Analysis for Evaluating Research on Juvenile Primary Fibromyalgia Syndrome (JPFS). CHILDREN 2022; 9:children9050637. [PMID: 35626815 PMCID: PMC9139718 DOI: 10.3390/children9050637] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 01/03/2023]
Abstract
Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome that affects children and adolescents. Methods: A VOSviewer-based bibliometric network analysis was performed by scanning the global literature on JPFS in the Web of Science (WOS) online database. The search string applied to identify the closest matching articles was “juvenile primary fibromyalgia syndrome (all field)”. Results: A total of 67 articles on JPFS were published from 1985 to March 2022, in the WOS. Regarding article types, 39 were research manuscripts, 16 reviews, 8 meeting abstracts, 2 letters, 1 book chapter, 1 correction, and 1 proceeding paper. The Quartile analysis demonstrated that 44% of papers were published in Q1, 37% in Q2, 8% in Q3, and 11% in Q4. Conclusions: Our analysis highlights that more efforts are warranted to increase the production of quality papers and enhance the connections between the various research groups. JFPS represents a research field still to be explored and which deserves greater investments to obtain quality scientific evidence.
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Abstract
Juvenile fibromyalgia is a common referral in pediatric rheumatology settings. Providing a clear diagnosis and explanation of altered pain processing offers reassurance that pain has a biologic basis and the symptoms are part of a recognized pain syndrome. Physicians should acknowledge the impact of chronic pain and associated symptoms on patient's lives and take time to understand contributing factors including stress, mood, inactivity, and lifestyle factors. The optimal treatment for juvenile fibromyalgia is multidisciplinary, focusing on education about juvenile fibromyalgia, along with physical therapy, cognitive behavioral therapy, sleep hygiene, healthy lifestyle habits, and medications for symptom management as appropriate.
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Affiliation(s)
- Jennifer E Weiss
- Pediatric Rheumatology, Hackensack Meridian School of Medicine, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Coles ML, Uziel Y. Juvenile primary fibromyalgia syndrome: A Review- Treatment and Prognosis. Pediatr Rheumatol Online J 2021; 19:74. [PMID: 34006290 PMCID: PMC8130260 DOI: 10.1186/s12969-021-00529-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome affecting children and adolescents. In part one of this review, we discussed the epidemiology, etiology, pathogenesis, clinical manifestations and diagnosis of JPFS. Part two focuses on the treatment and prognosis of JPFS. Early intervention is important. The standard of care is multidisciplinary, combining various modalities-most importantly, exercise and cognitive behavioral therapy. Prognosis varies and symptoms may persist into adulthood.
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Affiliation(s)
- Maya Levy Coles
- grid.415250.70000 0001 0325 0791Department of Pediatrics, Meir Medical Center, Pediatric Rheumatology Unit, Kfar Saba, Israel
| | - Yosef Uziel
- Department of Pediatrics, Meir Medical Center, Pediatric Rheumatology Unit, Kfar Saba, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Dougherty BL, Zelikovsky N, Miller KS, Rodriguez D, Armstrong SL, Sherry DD. Longitudinal Impact of Parental Catastrophizing on Child Functional Disability in Pediatric Amplified Pain. J Pediatr Psychol 2021; 46:474-484. [PMID: 33491076 PMCID: PMC8056213 DOI: 10.1093/jpepsy/jsaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Children with amplified musculoskeletal pain (AMPS) experience significant functional disability, with impairment in their ability to participate in age-appropriate activities of daily living. Parental factors play an important role in a child’s pain symptoms and treatment outcomes, with parental pain catastrophizing and protective behaviors linked to several maladaptive outcomes for children. Aims of the current study were to examine how parental pain catastrophizing, child pain catastrophizing, and parental protective behaviors longitudinally impacted functional disability for children with AMPS. Methods Archival data were examined from parent-child dyads presenting to a tertiary pain clinic for treatment of AMPS. Over 1 year, parents completed measures assessing the level of pain catastrophizing, common behavioral responses to child pain, and child functional disability. Children completed measures of pain catastrophizing and functional disability. Measures were collected at initial evaluation, 6-months, and 12-months. Latent growth models (LGM) were conducted to examine how to study variables longitudinally impacted the rate of change in child functional disability. Results Examining a comprehensive LGM of study variables, parental catastrophizing emerged as the sole contributing factor to slower improvement in functional disability. Conclusions The strong influence of parental pain catastrophizing on functional disability may relate to parents limiting behaviors that promote adaptive coping in children with pain. As such, parents who catastrophize may benefit from specific interventions to increase their use of adaptive behavioral responses, such as redirecting children to complete functional activities and encouraging the use of positive coping skills for pain-related distress.
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Affiliation(s)
| | | | - Kimberly S Miller
- Center for Amplified Musculoskeletal Pain Syndrome, Children's Hospital of Philadelphia, USA
| | | | | | - David D Sherry
- Center for Amplified Musculoskeletal Pain Syndrome, Children's Hospital of Philadelphia, USA
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Suicidal risk and resilience in juvenile fibromyalgia syndrome: a cross-sectional cohort study. Pediatr Rheumatol Online J 2021; 19:3. [PMID: 33407630 PMCID: PMC7789563 DOI: 10.1186/s12969-020-00487-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND To characterize suicidality among youth with juvenile fibromyalgia syndrome (JFMS) receiving treatment from pediatric rheumatologists at a tertiary care center in order to determine the prevalence of suicidality in JFMS and to explore risk factors for persistent suicidal ideation. METHODS We performed a cross-sectional cohort study of children 12-17 years old with JFMS seen in a specialty pediatric rheumatology pain clinic from 7/2017-9/2019. All subjects completed patient-reported outcomes measures, complemented by retrospective chart review. Subjects who endorsed item 8 on the Children's Depression Inventory, 2nd Edition (CDI-2) were categorized as endorsing suicidal ideation. We assessed for differences between the suicidal and non-suicidal patients using Wilcoxon-rank sum test. Logistic regression modeling was performed to identify psychosocial factors associated with suicidality. RESULTS Of the 31 subjects, more than one-quarter endorsed suicidality. Nearly 90% of teens with suicidal ideation were established in outpatient counseling. In bivariate analyses, suicidality was associated with lower resilience and greater depression and anxiety (all p < 0.05). Pain intensity trended towards a statistically significant positive association (OR: 1.16 [0.99-1.37]; p = 0.06). Lower resilience was independently associated with suicidality (OR: 0.90 [95% CI: 0.82-0.98]; p < 0.02). CONCLUSIONS Suicidality was prevalent among youth with JFMS and persistent despite concurrent receipt of mental health services. Higher patient-level resilience was independently associated with a reduced odds of suicidality. Future work should examine the role of resilience training on reducing psychological distress and mitigating the risk of suicidality in JFMS.
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Windsor RB, Sierra M, Zappitelli M, McDaniel M. Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders. CHILDREN-BASEL 2020; 7:children7120268. [PMID: 33276542 PMCID: PMC7761583 DOI: 10.3390/children7120268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.
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Affiliation(s)
- Robert Blake Windsor
- Division of Pediatric Pain Medicine, Department of Pediatrics, Prisma Health, Greenville, SC 29607, USA;
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Correspondence:
| | - Michael Sierra
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29607, USA
| | - Megan Zappitelli
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29607, USA
| | - Maria McDaniel
- Division of Pediatric Pain Medicine, Department of Pediatrics, Prisma Health, Greenville, SC 29607, USA;
- School of Medicine Greenville, University of South Carolina, Greenville, SC 29607, USA; (M.S.); (M.Z.)
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Prevalence of Juvenile Fibromyalgia Syndrome Among Children and Adolescents and its Relationship With Academic Success, Depression and Quality of Life, Çorum Province, Turkey. Arch Rheumatol 2020; 35:68-77. [PMID: 32637922 DOI: 10.5606/archrheumatol.2020.7458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/08/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to determine the frequency of juvenile fibromyalgia syndrome (JFMS) among children and adolescents in Çorum Province, Turkey, and its impact by comparing the levels of academic success, depression and quality of life (QoL) in individuals with and without JFMS. Patients and methods This was a cross-sectional study on 476 children and adolescents (245 boys, 231 girls; mean age 13.81±2.3 years; range, 9 to 17 years). The control group (non-JFMS group) consisted of 105 age- and sex-matched healthy participants (75 girls, 30 boys; mean age 14.1±1.8 years; range; 9 to 17 years). Participants' sociodemographic data, parental information, and school achievement in addition to data on chronic illness and drug use were collected via questionnaires (depression and QoL). A tender point (TP) examination was performed on each participant. Results Thirty-five (7.35%) of the participants (girls, n=25; boys, n=10) were diagnosed with JFMS. The number of minor JFMS diagnostic criteria, number of TPs, depression level and number of days the participants were absent from school were significantly higher in the JFMS group compared with the non-JFMS group (p<0.05). The mean grade point scores of the JFMS group were significantly lower than those of the non-JFMS group (p<0.05). The QoL subgroup scores as assessed by physical functioning, emotional functioning, social functioning and school-related problems of the JFMS group were significantly lower than the non-JFMS group (p<0.05). Age had a statistically significant negative correlation with QoL and school-related problems (r= -0.421, r= -0.494; p<0.05, respectively). Depression was negatively correlated with QoL and school-related problems (r= -0.672, r= -0.731; p<0.05, respectively). Conclusion Juvenile fibromyalgia syndrome affects QoL and can lead to school absenteeism, poor academic performance, depression and anxiety among the school-age population. Early identification of JFMS and early intervention may be the most effective strategy for preventing problems in later life.
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Lefèvre H, Loisel A, Meunier BB, Deslandre C, Lemoine N, Moro MR, Quartier P, Lachal J. Chronic idiopathic musculoskeletal pain in youth: a qualitative study. Pediatr Rheumatol Online J 2019; 17:86. [PMID: 31882011 PMCID: PMC6935211 DOI: 10.1186/s12969-019-0389-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP. METHODS Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data. RESULTS This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance. CONCLUSION The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management. CLINICAL TRIAL REGISTRATION clinicaltrials.gov, NCT03171792, https://clinicaltrials.gov/ct2/show/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.
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Affiliation(s)
- Hervé Lefèvre
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
- French Clinical Research Group in Adolescent Medicine and Health, Toulouse, France
| | - Alexandra Loisel
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
- APHP, Trousseau Hospital, Paris, France
| | - Brigitte Bader Meunier
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France
| | - Chantal Deslandre
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France
| | | | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
| | - Pierre Quartier
- Université de Paris, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l'Enfant (RAISE), Paris, France.
- APHP, Necker-Enfants Malades Hospital, Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Paris, France.
- Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 Rue de Sevres, 75015, Paris, France.
| | - Jonathan Lachal
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805, Villejuif, France
- Université de Paris, PCPP, Boulogne Billancourt, France
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Weiss JE, Schikler KN, Boneparth AD, Connelly M. Demographic, clinical, and treatment characteristics of the juvenile primary fibromyalgia syndrome cohort enrolled in the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. Pediatr Rheumatol Online J 2019; 17:51. [PMID: 31349785 PMCID: PMC6660676 DOI: 10.1186/s12969-019-0356-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/18/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To describe the demographic, clinical, and treatment characteristics of youth diagnosed with juvenile primary fibromyalgia syndrome (JPFS) who are seen in pediatric rheumatology clinics. METHODS Information on demographics, symptoms, functioning, and treatments recommended and tried were obtained on patients with JPFS as part of a multi-site patient registry (the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry). Data were summarized using descriptive statistics. In a subset of patients completing registry follow-up visits, changes in symptoms, pain, and functioning were evaluated using growth modeling. RESULTS Of the 201 patients with JPFS enrolled in the registry, most were Caucasian/White (85%), non-Hispanic (83%), and female (84%). Ages ranged from 9 to 20 years (M = 15.4 + 2.2). The most common symptoms reported were widespread musculoskeletal pain (91%), fatigue (84%), disordered sleep (82%), and headaches (68%). Pain intensity was rated as moderate to severe (M = 6.3 + 2.4/10). Scores on measures of functioning indicated mild to moderate impairment, with males observed to report significantly greater impairments. For the 37% of the initial cohort having follow-up data available, indicators of function and well-being were found to either worsen over time or remain relatively unchanged. CONCLUSIONS The symptoms of JPFS remained persistent and disabling for many patients treated by pediatric rheumatologists. Further study appears warranted to elucidate gender differences in the impact of JPFS symptoms. Work also is needed to identify accessible and effective outpatient treatment options for JPFS that can be routinely recommended or implemented by pediatric rheumatology providers.
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Affiliation(s)
- Jenifer E. Weiss
- 0000 0004 0407 6328grid.239835.6Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601 USA
| | - Kenneth N. Schikler
- 0000 0001 2113 1622grid.266623.5University of Louisville School of Medicine, Louisville, KY 40292 USA
| | - Alexis D. Boneparth
- 0000 0000 8499 1112grid.413734.6New York-Presbyterian Medical Center, New York, NY 10032 USA
| | - Mark Connelly
- 0000 0004 0415 5050grid.239559.1Children’s Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108 USA
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Gmuca S, Xiao R, Urquhart A, Weiss PF, Gillham JE, Ginsburg KR, Sherry DD, Gerber JS. The Role of Patient and Parental Resilience in Adolescents with Chronic Musculoskeletal Pain. J Pediatr 2019; 210:118-126.e2. [PMID: 30981421 DOI: 10.1016/j.jpeds.2019.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the level of resilience among patients with chronic musculoskeletal pain and their parents and to determine factors associated with patient and parental resilience. STUDY DESIGN Cross-sectional cohort study of children aged 13-17 years diagnosed with chronic musculoskeletal pain and their parents. Patient-parent pairs were seen for initial consultation in the pediatric rheumatology pain clinic at Children's Hospital of Philadelphia between March and May 2018 and were administered a series of questionnaires including measures of resilience (Connor-Davidson Resilience Scale 10 item, The 14-item Resilience Scale, and the 7Cs of Resilience Tool). We calculated Pearson correlation coefficients to examine the relationship between the variables of interest and resilience. RESULTS According to all resilience measures, patients and parents had low to moderate levels of resilience. These levels were lower than those previously reported among healthy populations, as well as those with chronic medical conditions. According to the Connor-Davidson Resilience Scale 10 item, patient-level resilience was negatively correlated with pain level (r = -0.48), physical disability (r = -0.54), and symptom severity (r = -0.53). The level of resilience among patients was positively correlated with energy level (r = 0.57) and health-related quality of life (r = 0.64). Parental resilience was positively correlated with parental mental health (r = 0.61). CONCLUSIONS Higher patient resilience was correlated with reduced disease severity among adolescents with chronic musculoskeletal pain. Future research should explore whether fostering resilience in adolescents with chronic musculoskeletal pain via the application of resilience-training interventions mitigates disease burden in this vulnerable patient population.
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Affiliation(s)
- Sabrina Gmuca
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA
| | - Audrey Urquhart
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Pamela F Weiss
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jane E Gillham
- Department of Psychology, Swarthmore College, Swarthmore, PA
| | - Kenneth R Ginsburg
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David D Sherry
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeffrey S Gerber
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Division of Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA
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Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People. Pain Res Manag 2019; 2019:6584753. [PMID: 31191788 PMCID: PMC6525804 DOI: 10.1155/2019/6584753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
Although the life-course concept of risk markers as potential etiological influences is well established in epidemiology, it has not featured in academic publications or clinical practice in the context of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Studies of risk markers are required considerations for evaluation of patients and for research because there is no single cause, pathological feature, laboratory finding, or biomarker for CWP or FMS. The early-life risk markers identified by extensive literature review with best evidence for potential causal influence on the development and progression of CWP and FMS include genetic factors, premature birth, female sex, early childhood adversity, cognitive and psychosocial influences, impaired sleep, primary pain disorders, multiregional pain, physical trauma, infectious illness, obesity and inactivity, hypermobility of joints, iron deficiency, and small-fiber polyneuropathy. The case history illustrates the potential etiological influence of multiple risk markers offset by personal resilience.
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De Sanctis V, Abbasciano V, Soliman AT, Soliman N, Di Maio S, Fiscina B, Kattamis C. The juvenile fibromyalgia syndrome (JFMS): a poorly defined disorder. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:134-148. [PMID: 30889168 PMCID: PMC6502146 DOI: 10.23750/abm.v90i1.8141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/20/2019] [Indexed: 12/31/2022]
Abstract
Juvenile fibromyalgia syndrome (JFMS) is a chronic condition characterized by symptoms of chronic diffuse musculoskeletal pain and multiple painful tender points on palpation. It is often accompanied by fatigue, disorders of sleep, chronic headaches, irritable bowel syndrome, and subjective soft tissue swelling. The complexity of the presenting clinical picture in JPFS has not been sufficiently defined in the literature. Similarities to adult fibromyalgia syndrome in JFMS are often difficult to compare, because many of the symptoms are "medically unexplained" and often overlap frequently with other medical conditions. However, a valid diagnosis of JFMS often decreases parents' anxiety, reduces unnecessary further investigations, and provides a rational framework for a management plan. The diagnostic criteria proposed by Yunus and Masi in 1985 to define JFMS were never validated or critically analyzed. In most cases, the clinical diagnosis is based on the history, the physical examination that demonstrates general tenderness (muscle, joints, tendons), the absence of other pathological conditions that could explain pain and fatigue, and the normal basic laboratory tests. Research and clinical observations defined that JFMS may have a chronic course that impacts the functional status and the psychosocial development of children and adolescents. This paper briefly reviews the existing knowledge on JFMS focusing on the diagnosis, clinical and the epidemiological characteristics in children and adolescents for better understanding of this disorder.
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Affiliation(s)
- Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
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Healthcare Use Patterns and Economic Burden of Chronic Musculoskeletal Pain in Children before Diagnosis. J Pediatr 2018; 197:172-176. [PMID: 29625732 DOI: 10.1016/j.jpeds.2018.01.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/22/2017] [Accepted: 01/27/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the healthcare use and costs of amplified musculoskeletal pain syndrome (AMPS) in children before diagnosis. STUDY DESIGN We performed a retrospective study in children with AMPS at a pediatric rheumatology clinic between 2010 and 2014. Data were abstracted on 80 patients after primary rheumatic diseases were excluded. Healthcare visits, medications and diagnostic testing that occurred in the years before diagnosis were collected. The Medical Expenditure Panel Survey was used to estimate visit costs. RESULTS Patients were adolescent females (89%) and white (86%). The median time to diagnosis was 10.2 months. The median pain score was 6.5 and the median Childhood Health Assessment Questionnaire score was 1.1. In this cohort, 29% had at least 1 ED visit and 5% were hospitalized. All patients saw a rheumatologist and 41% had visited another specialist, typically orthopedics and sports medicine. More than one-half had at least 1 radiographic study and 21% had at least 1 magnetic resonance imaging. The total cost for office, emergency department, and hospital visits for AMPS in all 80 patients was $152 853. The mean cost per patient over the entire study period (2008-2014) was $1911 ± $3808, and 43% of costs were outpatient visits. CONCLUSIONS Children with AMPS have high levels of disability and take a long time to be diagnosed. As a result, even before diagnosis, they have high levels of healthcare use, diagnostic testing, and medical costs. Early recognition of disability and quicker referral to trained subspecialists may improve the prognosis, reduce unnecessary testing, and reduce the overall costs of healthcare.
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Beals-Erickson SE, Connelly M. Current Understanding of Optimal Self-Management Strategies and Approaches for Youth With Amplified Musculoskeletal Pain Conditions. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0087-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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