Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals.
Fibromyalgia is commonly thought of as a condition that affects adults. However, fibromyalgia also occurs in children and adolescents. Estimates suggest that juvenile-onset fibromyalgia affects 2% to 6% of schoolchildren, mostly adolescent girls. It is most commonly diagnosed between ages 13 and 15.
In some children, symptoms begin after a triggering event, such as physical trauma, surgery, infection or prolonged psychological stress. In other children, symptoms gradually accumulate over time with no single triggering event.
In children with fibromyalgia, signs and symptoms include:
- Widespread pain. The pain associated with fibromyalgia often is described as a dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.
- Headache. Frequent headaches occur in a majority of children who have fibromyalgia.
- Sleep disturbances. Despite complaints of severe fatigue, these children often take an hour or more to fall asleep. Even when they do fall asleep, many have difficulty maintaining sleep and wake up during the night.
- Fatigue. People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Many children with fibromyalgia have other sleep disorders, such as restless legs syndrome.
- Other problems. Children who have fibromyalgia may also have pain or cramping in the lower abdomen with constipation or diarrhea. They may also have trouble paying attention or concentrating. Depression and anxiety are common in people who have fibromyalgia.
Doctors don't know why some people develop fibromyalgia and others don't. There appears to be a genetic component because the condition tends to run in families. In some people, it may be triggered by specific events, injuries or illnesses.
Why does it hurt?
Researchers believe repeated nerve stimulation causes changes in the brain and spinal cord of people with fibromyalgia. These changes include an abnormal increase in levels of certain chemicals in the brain that signal pain. In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become sensitized, meaning they can overreact to painful and nonpainful signals.
Risk factors for fibromyalgia include:
- Your sex. Fibromyalgia is diagnosed more often in girls and women.
- Family history. You may be more likely to develop fibromyalgia if a parent or sibling also has the condition.
- Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop fibromyalgia.
The pain and lack of sleep associated with fibromyalgia can interfere with the ability to function at school or at home. The frustration of dealing with an often misunderstood condition can result in depression and anxiety.
In the past, doctors would check specific points on a person's body to see how many were painful when pressed firmly. Newer guidelines don't require a tender point exam.
Instead, a fibromyalgia diagnosis can be made, using adult guidelines, if a young person has had widespread pain throughout the body for at least three months. Widespread is defined as pain on both sides of the body, as well as above and below the waist.
Your doctor may also order blood tests or X-rays to help rule out other problems that might be causing the symptoms.
Treatment for juvenile fibromyalgia may include exercise programs, counseling and medications.
Graded exercise therapy
Many children who have fibromyalgia avoid activity because they're afraid it will cause more pain. It may help to start with strength-training exercises to improve gait, posture and balance. Activities such as biking, swimming or water aerobics can be added gradually.
Cognitive behavioral therapy is a type of talk therapy that has been well studied in the treatment of chronic pain in children. It focuses on helping them manage their pain using techniques such as relaxation-based treatments, distraction and thought stopping. These techniques can help reduce disability and depression. Combining an exercise program with cognitive behavioral therapy can provide significant benefit.
Medications can help reduce the pain of fibromyalgia and improve sleep. Data on the use of medications in the treatment of juvenile fibromyalgia is limited. However, drugs that have shown benefit in adults have also been used in children and are sometimes effective. Common choices include:
- Antidepressants. Duloxetine (Cymbalta, Drizalma) and milnacipran (Savella) can help ease pain and fatigue. Amitriptyline may help ease pain and promote sleep. Other antidepressants may including fluoxetine (Prozac, Sarafem, others), venlafaxine (Effexor XR) or bupropion (Wellbutrin SR, Contrave, others).
- 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 adolescents to reduce fibromyalgia pain.
Lifestyle and home remedies
Self-care is critical in the management of fibromyalgia:
- Stress management. 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.
- Sleep hygiene. Because fatigue is one of the main components 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, limiting daytime napping, and limiting digital screen usage at nighttime.
- 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.
Yoga, tai chi and qigong combine meditation, slow movements, deep breathing and relaxation. In adults with fibromyalgia, these practices can decrease sleep problems, fatigue and depression. The same may be true for children as well.
Other related strategies include massage and acupuncture; these practices can also help decrease pain, improve fatigue, reduce anxiety and promote higher quality sleep.
Preparing for an appointment
Because many of the signs and symptoms of fibromyalgia are similar to those of other disorders, you may see several doctors before receiving a diagnosis. Your family physician may refer you to a doctor who specializes in the treatment of arthritis and other similar conditions (rheumatologist).
What you can do
Before your appointment, you may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you've had in the past
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
In addition to doing a physical exam, your doctor will probably ask you if you have problems sleeping and if you've been feeling depressed or anxious.