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Fibromyalgia in children and teens
Monday 15 March 2010
Fibromyalgia in Children & Teens - Risk Factors, Symptoms, and Treatment
by Dr. Mark J. Pellegrino, MD*
“In my practice I see many youngsters with fibromyalgia, often children of a parent with FM or connective tissue disease,” writes Dr. Pellegrino. But fortunately, he has found, those who are diagnosed and learn to manage their FM earlier in life tend to be among the two-thirds of fibromyalgia patients whose symptoms stabilize or improve over time.
Women do not have a monopoly on fibromyalgia. I see many children and men with FM in my practice. As a man with fibromyalgia who had various symptoms as a child, I can appreciate that the “minority” hurts too, and their lives are disrupted by fibromyalgia. As you’ve come to appreciate by now, not everyone with FM is affected the same, and there are some unique differences among children… that require some different strategies.
Children with Fibromyalgia
Other risk factors I’ve identified in children include the presence of scoliosis (curvature of the spine) or forward posturing (rounded shoulders). Postural changes cause more strain on the back muscles which over time can lead to traumatic changes that trigger fibromyalgia.
Girls are more likely to have scoliosis than boys (genetic risk). I see many youngsters who have intermittent back strains related to postural changes, and some have gone on to develop “full blown” fibromyalgia. There is no way to predict who will develop clinical fibromyalgia in those who are at risk, especially in those who are completely symptom-free.
In children, girls still outnumber boys, but the gap is smaller - about 60% girls and 40% boys in a survey of people younger than 18 with FM in my practice. This three to two ratio is consistent with the research reported by Dr. D Buskila.(3) In the adult population, diagnosed women outnumber men by at least six to one, but if we go out and look for FM, we will find it in men who have never gone to the doctor.
Primary fibromyalgia is more common.
Common Initial Symptoms
1. Leg pains (may be called growing pains). This appears to be a form of restless leg syndrome in children and is especially bothersome at night.
• I find that many children will experience increased pain or more widespread pain during growth spurts. Perhaps fibromyalgia is thrown “out of balance,” so to speak, as growth is occurring more rapidly than the fibromyalgia can adjust, hence the increased pain. The stress of growth may aggravate FM symptoms, or perhaps the nerves grow at a slower pace than the rest of the body and they signal more nerve pain.
Usually I will obtain some lab work including blood counts, sedimentation rate, and possible thyroid studies. If cognitive difficulties are a problem I will consider neuropsychological testing to specifically test memory, auditory comprehension, reading comprehension, and other integrative skills of the brain.
My treatment philosophy with children is mainly “let kids be kids.” Children are active, they tend to sleep more, and they can be moody. Sometimes parents’ concerns are based more on the parents’ experience with fibromyalgia – and fear that the child may be going through the same thing.
I address these concerns and try to offer encouragement. I believe that minimal invasiveness is required. The main treatment may simply be a matter of reassuring the child and parent that there is no serious medical condition, but rather there is some evidence of fibromyalgia which can be handled with education, and tailoring an activity program to include stretches and specific exercises, nutritional approaches, and long-term monitoring.
When More Is Needed
Treatments could include specific, prescribed medicines such as klonopin [a sleep inducing, relaxing drug], nortriptyline [an antidepressant], or a mild pain medication. I may prescribe a therapy program to try to find out what works and to develop a successful home program. Nutritional strategies, education, manual therapy and stress management are other treatments to consider.
1. Rescheduling student classes so the student may be able to arrive later and leave earlier, and have a study hall/rest time in the middle of the day.
Sometimes it is necessary to temporarily remove the child from school and use a home tutor. If the process of getting to and from school is extremely difficult because of pain and fatigue, this may be a reluctant but necessary option.
When a Certain Activity is the Aggravating Factor
Several of my female patients were interested in a dancing major in college, but they developed FM along the way that was made worse by repetitive dancing. I advised them about changing their major to one that was more realistic and did not involve activities that aggravate the fibromyalgia. Dancing could still be pursued as recreation, but FM would probably not allow it as a career.
If gymnastics, tennis, or any other competitive sport activity appears to be a major factor in the cause of fibromyalgia and of flare-ups, I will tell the young athlete to think about a different competitive sport.
• First, they will back off from the activity, get the FM under the best control possible, and then see what happens when the activity is resumed.
Good Chance of Control
Even if the mother is having a difficult time with her fibromyalgia, the child can reach a stage where the FM is hardly a bother. Most of the children I’ve seen have done better over time, and I am hopeful that they will continue to do well.
* Dr. Mark J Pellegrino, MD, specializes in physical medicine and rehabilitation, and has seen more than 20,000 fibromyalgia patients in his clinical practice at the Ohio Rehab Center. This article is excerpted with kind permission from his highly regarded book, Fibromyalgia, Up Close and Personal. © Anadem Publishing, Inc. and Mark Pellegrino, MD, 2005, all rights reserved. This book may now be ordered in the ProHealth.com store.
Note: This information has not been evaluated by the FDA. It is not meant to diagnose, prevent, treat or cure any illness, condition, or disease, and should not replace the attention of your personal healthcare professional. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.
The article originally appeared here.
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