Adolescent Fibromyalgia: A Diagnostic Quandary
Emerging from decades of debate over whether or not it exists, fibromyalgia is now well known and easily recognized among physicians familiar with the syndrome. A few "hold outs" remain, who still believe that the symptoms of fibromyalgia are a product of depressed female hypochondriacs. Of all the sufferers of fibromyalgia, more than 80% are women in their 30's and 40's. However, adolescent fibromyalgia is becoming much clearer than in the past decades.
Fibromyalgia is a connective tissue and auto-immune syndrome characterized by up to 18 painful trigger points on the body, chronic fatigue, sleep disturbance, irritable bowel, depression, sensitivity to heat and cold, oral thrush and vulnerability to colds and the flu. Although the syndrome has been studied for at least 150, fibromyalgia's cause remains unknown; by treating its symptoms, long-term sufferers find relief from the most common and debilitating aspects of this mystifying disorder.
Identifying Adolescent Fibromyalgia
Most rheumatologists who treat adolescent fibromyalgia patients believe that the condition is under-diagnosed. In many ways, the stereotype of fibromyalgia being an adult woman's syndrome is still widely assumed. However, a thorough patient history of an adolescent's presenting complaints can tip off a knowledgeable physician that the history and physical examination reveals the presence of adolescent fibromyalgia. This syndrome can disguise itself as many other unrelated conditions such as the fatigue of mononucleosis, lack of restorative sleep due to social anxiety, joint and muscle tenderness due to sports activities, and the psychological "angst" of simply being a teenager. Thus, the true syndrome of adolescent fibromyalgia is often misdiagnosed and untreated.
As with adult women, most cases of adolescent fibromyalgia occur among females who have reached the age of having regular menstrual periods. Since there are no documented cases of adolescent fibromyalgia among pre-pubescent girls, this may confirm the long-held theory that women are more susceptible to this syndrome because of hormonal fluctuations, especially when they are pre-menstrual or in menopause. Adolescent fibromyalgia's age of onset coincides with the beginning of menstruation, breast growth, and the development of pubic hair.
Adolescents with fibromyalgia usually have a mother or older sibling with this syndrome. They present for medical treatment after a worried mother recognizes the development of the classic pattern of symptoms that she knows very well. The treatment for adolescent fibromyalgia is virtually identical to that of adult women; the focus is on pain relief with non-narcotic and non-steroidal medication and also medication that restores deep REM sleep. Gabapentin and tricyclic anti-depressants such as Elavil can bring relief from the pain of trigger points on the body. Adolescents with fibromyalgia also benefit from low-impact stretching exercise and massage therapy.