Fibromyalgia: Treating Pain in the Juvenile Patient

Abstract

Presently, evidence for the efficacy of medications for the treatment of juvenile fibromyalgia syndrome (JFMS) is limited. While there are medications approved by the US Food and Drug Administration (duloxetine, milnacipran and pregabalin) for adults with fibromyalgia syndrome, there are none for the treatment of JFMS. A variety of medications have been prescribed for the treatment of JFMS, including (but not limited to) non-opioid analgesics, opioids, anticonvulsants, antidepressants, and muscle relaxants. Psychological therapies, most prominently cognitive behavioral therapy, are the most evidenced-based treatment modalities for JFMS. A multidisciplinary approach, combining pharmacological, behavioral and exercise-based modalities is currently the standard of care for JFMS. In the future, more stringent randomized, controlled trials with longer follow-up periods are needed in order to determine the long-term efficacy and safety of medications in the treatment of JFMS. Additionally, improved recognition of JFMS will allow for better patient recruitment to permit for adequately powered study designs.

Figure 1. Spectrum of Amplified Musculoskeletal Pain Syndromes

Legend. There is significant overlap between the various pain manifestations. Along with pain, all patients are likely to have some degree of fatigue, muscle aches, sleep and mood disturbances along with a host of other possible somatic complaints (see 2010/2011 fibromyalgia criteria, Table 3).