Specific definitions and criteria for chronic sickle pain in youth are needed. Identifying risk and protective factors related to the transition from acute to chronic pain is important to facilitate improved psychosocial functioning.

WHAT'S KNOWN ON THIS SUBJECT: Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition, typically identified in adolescence and accompanied by physical and social impairment and mood difficulties. There are no long-term studies on the prognosis of adolescents with JFM into adulthood. WHAT THIS STUDY ADDS:This prospective study demonstrated that pain and other symptoms persisted into adulthood for .80% of JFM patients, with associated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adult fibromyalgia. abstractOBJECTIVE: This prospective longitudinal study examined the long-term physical and psychosocial outcomes of adolescents with juvenile-onset fibromyalgia (JFM), compared with healthy control subjects, into early adulthood.METHODS: Adolescent patients with JFM initially seen at a pediatric rheumatology clinic (n = 94) and age-and gender-matched healthy control subjects (n = 33) completed online measures of demographic characteristics, pain, physical functioning, mood symptoms, and health care utilization at ∼6 years' follow-up (mean age: 21 years). A standard in-person tender-point examination was conducted. RESULTS:Patients with JFM had significantly higher pain (P , .001), poorer physical function (P , .001), greater anxiety (P , .001) and depressive symptoms (P , .001), and more medical visits (P , .001) than control subjects. The majority (.80%) of JFM patients continued to experience fibromyalgia symptoms into early adulthood, and 51.1% of the JFM sample met American College of Rheumatology criteria for adult fibromyalgia at follow-up. Patients with JFM were more likely than control subjects to be married and less likely to obtain a college education.CONCLUSIONS: Adolescent patients with JFM have a high likelihood of continued fibromyalgia symptoms into young adulthood. Those who met criteria for fibromyalgia in adulthood exhibited the highest levels of physical and emotional impairment. Emerging differences in educational attainment and marital status were also found in the JFM group. JFM is likely to be a long-term condition for many patients, and this study for the first time describes the wide-ranging impact of JFM on a variety of physical and psychosocial outcomes that seem to diverge from their same-age peers.

A recent randomized multi-site clinical trial found that cognitive-behavioral therapy (CBT) was significantly more effective than fibromyalgia education (FE) in reducing functional disability in adolescents with juvenile fibromyalgia (JFM). The primary objective of this study was to examine the psychological processes of CBT effectiveness by evaluating changes in pain coping, catastrophizing, and coping efficacy and test these changes as mediators of continued improvements in functional disability and depressive symptoms at 6-month follow-up. One hundred adolescents (11–18 years old) with JFM completed the clinical trial. Coping, catastrophizing, and coping efficacy (Pain Coping Questionnaire) and the outcomes of functional disability (Functional Disability Inventory) and depressive symptoms (Children’s Depression Inventory) were measured at baseline, post-treatment, and 6-month follow-up. Participants in both conditions showed significant improvement in coping, catastrophizing, and efficacy by the end of the study, but significantly greater improvements were found immediately following treatment for those who received CBT. Treatment gains were maintained at follow-up. Baseline to post-treatment changes in coping, catastrophizing, and efficacy were not found to mediate improvements in functional disability or depressive symptoms from post-treatment to follow-up. Future directions for understanding mechanisms of CBT effectiveness in adolescents with chronic pain are discussed.