PEDIATRIC FIBROMYALGIA

PEDIATRIC FIBROMYALGIA

In the USA national pediatric rheumatology clinic registry, FMS is now the third most common new patient diagnosis.

Fibromyalgia affects the same cells, systems and organs in children as in adults, but children pay much less attention to the overall picture.
We have to care for:
  •  Growing pains" in the lower limbs which begin before the great growth spurt of approaching  puberty;
  •  Fatigue in the mornings beyond what seems normal;
  •  Spontaneous naps at times when other children are out playing;
  •  Dizziness and exhaustion for no particular reason;
  •  Difficulty with concentration or eye that do not always focus;
  •  Difficulty with memory;
  •  Abdominal pain;
  •  Constipation or diarrhea abnormally persistent or alternating;
  •  Young girls with bladder infections, or with pelvic pain, or painful urination;
  •  Dysmenorrhea or premenstrual syndrome which aggravates the other symptoms;
  •  Headaches or migraines.
 
Let me point out some specific symptoms in adolescent fibromyalgia.
Sleep disturbance is virtually universal in these teenagers, and should be thoroughly explored in the history. They fall asleep easily but experience night-time awakening without obvious provocation. These teens have nonrestorative sleep, but they may not know it, and report that they never feel rested in the morning. The adolescent, boy or girl, who states that he feels much better (both with regard to fatigue and pain) when he allows himself a specific adequate amount of sleep (9 to 10 hours) is less likely to have fibromyalgia.
The fatigue is persistent when they try to keep up with their usual physical, intellectual and recreational routines. Parents often say: "My child just doesn't seem to have the energy for anything. Something is wrong with her."
Adolescents with fibromyalgia often struggle with concentration and memory as well as symptoms of depression. The clinical interview should determine whether the primary disorder is depression with associated somatization and fatigue, or if the mood disturbance is secondary to the pain and fatigue of fibromyalgia. This distinction is important because only a primary psychosomatic depression will need further psychological evaluation.
Because of the prominence of musculoskeletal pain, rheumatologic disorders such as juvenile arthritis (JA) are often the initial consideration. An absence of joint (or soft tissue) inflammation, of limitation of movements, and of blood tests for arthritis, makes rheumatologic disorders unlikely. Swelling (typically in hands and fingers) often reported by teenagers suffering from fibromyalgia is not the result of joint effusion, and is usually not confirmed by physician on physical examination, and when confirmed, no signs of arthritis is noticed.
 
Early in the course of their illness, children and adolescents have much less tender points than adults. Therefore, 11 tender points are not mandatory for the diagnosis of pediatric fibromyalgia.
 
We need to make the diagnosis of fibromyalgia in the young as soon as possible, and treat their disease. The swollen fibromyalgic lesions (lumps and bumps) are easily discovered with the mapping, which greatly facilitates making the diagnosis. This is especially valuable in the younger patients who are often unable to describe their symptoms.
GUAIFENESIN is safe for adults and children at any age. The road back from fibromyalgia is more easily traveled in the early stages. The parents are fortunate to have a medicine that can quickly restore their children to normal. Life would certainly have been happier with far fewer wasted years of suffering if, for themselves, the parents had had the opportunity for early diagnosis and treatment.
norkurld@zahav.net.il
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