Juvenile primary fibromyalgia syndrome (JPFS) is a poorly understood pain condition that occurs in childhood and adolescence and is more commonly diagnosed in adolescent girls. Widespread and persistent pain, multiple tender or trigger points on physical examination, sleep difficulties, fatigue, and mood disturbance are the most common presenting symptoms. The greater prevalence of JPFS in girls (1) corresponds with the greater prevalence of fibromyalgia in adult women (2). Much controversy exists among biobehavioral researchers and practitioners about the causes, nature, and appropriate treatment of fibromyalgia in adults (3). Much less is known about the etiology and treatment of fibromyalgia in children. Given the chronic nature of the symptoms and the extent of suffering and disability associated with this condition in adulthood (4), early recognition, diagnosis, and intervention in children is of the utmost importance. This article first reviews the existing literature on JPFS and draws upon relevant findings from research in adult fibromyalgia to enhance an understanding of potential etiological factors in JPFS. Next, we propose a preliminary conceptual model using a biopsychosocial perspective to integrate what is known about biologic and psycho-social mechanisms in the etiology of JPFS. Finally, promising treatments for JPFS and suggestions for future research are discussed.
How prevalent is JPFS?
Limited epidemiological data are available on the prevalence of JPFS, but awareness and recognition of this condition are beginning to increase among the medical community and other health providers. The prevalence estimates of fibromyalgia in the adult population are about 3.4% for women as compared with 0.5% for men (2). JPFS is more commonly diagnosed in adolescent girls between the ages of 13 and 15, particularly among those who are white . The available data suggest that JPFS is a significant problem that is frequently encountered in pediatric rheumatology practices in the United States. The Penta Group Registry of Rheumatology Clinics in the Ohio, Indiana, and Kentucky region includes 231 children diagnosed with fibromyalgia. Recent reports indicate an increasing proportion of new patient diagnoses of JPFS in pediatric rheumatology clinics. In 1996, Bowyer and Roettcher (6) reported that JPFS accounted for 2.1% of new patient diagnoses in a US pediatric rheumatology clinic disease registry. This figure had been updated to 7.65% of new patient diagnoses in the same disease registry in 1998 (5). Siegel and colleagues (5) reported that JPFS ranked third among new patient diagnoses at their pediatric rheumatology clinic. These figures do not take into account the patients who are seen at pediatric primary care clinics. Data from population-based studies in Israel, Finland, and Mexico provide additional information on the prevalence of JPFS. In a large study of 1,756 Finnish schoolchildren, Mikkelsson and colleagues