Juvenile fibromyalgia

The diagnosis of juvenile fibromyalgia is made clinically and is based on a history of chronic, generalized pain and associated features (fatigue, sleep disturbances, headache and depression), a physical examination that demonstrates the presence of tender points and excludes other diagnoses, and negative or normal laboratory tests.

Although the American College of Rheumatology criteria for fibromyalgia weren't written specifically for children, they are sometimes used for children and adolescents.

The Yunus and Masi criteria, on the other hand, are specifically for juvenile fibromyalgia. The diagnosis is based on the presence of all of the major criteria plus three of the 10 minor criteria:

Major criteria

• Generalized musculoskeletal aching at three or more sites for at least three months
• Absence of an underlying condition or cause (for example, arthritis or trauma)
• Normal test results
• Five tender points

Minor criteria

• Chronic anxiety or tension
• Fatigue
• Poor sleep
• Chronic headaches
• Irritable bowel syndrome
• Subjective soft tissue swelling
• Numbness
• Pain modulation of physical activity
• Pain modulation by weather factors
• Pain modulation by anxiety and stress

Blood tests

While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions, such as juvenile arthritis, that may have similar symptoms. Blood tests may include:

• Complete blood count
• Erythrocyte sedimentation rate
• Thyroid function tests

A multidisciplinary approach that incorporates clinicians, psychologists and rehabilitation specialists and that offers a combination of pharmacological, cognitive behavioral and physical interventions, along with patient education, has been shown to be most effective in treating children and teens with fibromyalgia.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Data on the use of medications in the treatment of juvenile fibromyalgia are limited. However, agents that have shown benefit in adults also have been used in children, and are sometimes effective. Common choices include:

• Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Other antidepressants, such as amitriptyline and fluoxetine (Prozac), are sometimes prescribed and appear to help promote sleep.
• Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Pain reliever such as tramadol (Ultram, Conzip) are also sometimes prescribed. Use of opioids and narcotics should be avoided in treating juvenile fibromyalgia.
• Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are sometimes prescribed for adults to reduce fibromyalgia symptoms.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is an intervention that has been well-studied in the treatment of chronic pain in children, and has been found to help reduce disability and depression. CBT focuses on helping people with fibromyalgia manage their pain using adaptive coping skills. These include the use of relaxation-based treatments, distraction, activity pacing, scheduling pleasant activities, problem-solving, and replacing negative and catastrophic thoughts with more calming and realistic appraisals.

For children and adolescents with fibromyalgia, parents usually participate in some CBT sessions to learn how to coach and support their children's use of these coping skills at home.

Self-care is critical in the management of fibromyalgia:

• Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
• Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
• Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
• Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
• Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. Indeed, today some alternative therapies have gained acceptance in mainstream medicine.

The following practices appear to safely relieve stress and reduce pain, thereby helping people with fibromyalgia manage their symptoms:

• Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.
• Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.