CINCINNATI, Ohio—Cognitive behavioral therapy (CBT) is a promising intervention for adolescents with juvenile primary fibromyalgia syndrome (JPFS), but using it successfully is likely to require taking into account the sometimes difficult family characteristics and dynamics that surround these patients, researchers suggest in Arthritis Care & Research.¹

Susmita Kashikar-Zuck, PhD, and colleagues at Cincinnati Children's Hospital Medical Center in Ohio compared 47 adolescents with JPFS to 48 comparison subjects without chronic illness matched for age, sex, and race. Subjects and their mothers completed a battery of standardized assessments that included demographic background, the Children's Depression Inventory, the Child Behavior Checklist, the Self-Perception Profile for Adolescents, the Modified Fibromyalgia Impact Scale for Children, the Parent Pain History Questionnaire, the Symptom Checklist-90-Revised, and the Family Environment Scale.

“Adolescents with JPFS had greater internalizing and externalizing symptoms than healthy comparison peers. Mothers of adolescents with JPFS reported twice as many pain conditions and significantly greater depressive symptoms than mothers of comparison peers. The JPFS group also had poorer overall family functioning and conflicted family relationships. In adolescents with JPFS, maternal pain history was associated with significantly higher functional impairment,” Dr. Kashikar-Zuck said.

The investigators point out that familial aggregation of fibromyalgia symptoms and coaggregation of mood and anxiety disorders in adults with fibromyalgia suggest that genetic factors play a major role in the syndrome. They also point out that familial environment strongly influences pediatric pain and disability including such factors as parental solicitousness, family conflict, cohesiveness, parental pain history, and coping. The objective of the study was to assess the impact of those factors in juvenile fibromyalgia.

The researchers found

• greater emotional and behavioral difficulties in adolescents with JPFS (as reported
  by their mothers)
• more internal symptoms such as anxiety and depression in adolescents with JPFS
• more external symptoms such as difficulties with attention and conduct problems
• significantly worse depressive symptoms in mothers of JPFS kids than in mothers
  of control subjects
• mothers of JPFS kids had twice as many pain conditions for which they
  were receiving treatment, and were four times more likely than mothers
  of control subjects to have fibromyalgia themselves

“[W]e found that after adolescents’ pain levels were taken into account, maternal pain history was the only variable that was significantly associated with level of impairment in adolescents with JPFS.”

Furthermore, JPFS family relationships had “higher levels of conflict, lower levels of cohesion, and less organizational structure than comparison families.” However, the data did not show that family environment was significantly associated with impairment in JPFS adolescents.

More research on family issues in JPFS needed

The researchers warn that the results do not necessarily apply to adolescents who are not patients in pediatric rheumatology clinics. Dr. Kashikar-Zuck noted that family environment and emotional functioning should be considered an important aspect of CBT interventions in adolescent fibromyalgia and that family factors might be important in determining whether the benefits of CBT “are supported or eroded over time.”


Reference

1. Kashikar-Zuck S, Lynch AM, Slater S, et al. Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome. Arthritis Care Res. 2008;59:1392-1398.