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Long-Term Outcomes of Adolescents With Juvenile-Onset Fibromyalgia in Early Adulthood
Open accessAbstract
OBJECTIVE: 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.
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“Frequently, symptoms sustain into adulthood, carrying a significant risk of long-term impairment, reduced probability of obtaining a higher education and a high use of health care costs [9–13].”
From Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: A pilot study (2020) · cites this paper as [9]
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“and are less likely to obtain a college education.9”
From Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial (2016) · cites this paper as [9]
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“A substantial proportion show continuity of functional symptoms into adulthood9–11”
From Comparing group-based acceptance and commitment therapy (ACT) with enhanced usual care for adolescents with functional somatic syndromes: A study protocol for a randomised trial (2016) · cites this paper as [9]
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“In at least a subset of youth with JPFS, pain is associated with significant and enduring impairment in the ability to participate in usual activities and maintain positive well-being [4–7].”
From Pain, functional disability, and their Association in Juvenile Fibromyalgia Compared to other pediatric rheumatic diseases (2019) · cites this paper as [6]
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“Youth with JPFS often are likely to have comorbid symptoms of anxiety and depression, which can further augment pain perception and problems with functioning and quality of life [6].”
From Pain, functional disability, and their Association in Juvenile Fibromyalgia Compared to other pediatric rheumatic diseases (2019) · cites this paper as [6]
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“JFM affects 2–6% of school-age children [7–11] and commonly persists into adulthood [12].”
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Lunde, C. E., Fisher, E., Donovan, E., Serbic, D., & Sieberg, C. B. (2022) · Paediatric and Neonatal Pain · doi:10.1002/pne2.12072 · Cited by 10
Dudeney, J., Scott, A. J., Hathway, T., Bisby, M. A., Harte, N., Titov, N., & Dear, B. F. (2024) · The Journal of Pain · doi:10.1016/j.jpain.2023.12.004 · Cited by 9
Foxen-Craft, E. C., Bourchtein, E., Kaplan, C. M., Clauw, D. J., & Scott, E. L. (2022) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001083 · Cited by 8
Patient-proxy agreement on health-related quality of life in juvenile fibromyalgia syndrome
Gmuca, S., Xiao, R., & Sherry, D. D. (2019) · Pediatric Rheumatology · doi:10.1186/s12969-019-0320-y · Cited by 8
Baseline Characteristics of a Dyadic Cohort of Mothers With Chronic Pain and Their Children
Wilson, A. C., Stone, A. L., Cordts, K. M. P., Holley, A. L., Mackey, S., Darnall, B. D., & Palermo, T. M. (2020) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000864 · Cited by 9
Fibromyalgia—Toward a Definition in Children
Hoffart, C. M., & Sherry, D. D. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.11.034 · Cited by 7
“Historically, as Kashikar-Zuck et al have reported, the outcome is dire for adolescents with JFM with the treatments offered in the last few decades.(9) By better defining study populations, we can work toward establishing evidence-based therapies and improve the prognosis in both localized and diffuse pain, as each c…”
BackgroundTran, S. T., Bieniak, K. H., Bedree, H., Adler, M. J., Ogunmona, S., Kovar-Gough, I., Ma, W., Thabrew, H., & Cunningham, N. R. (2024) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsae097 · Cited by 6
Self-citationLavarello, C., Ancona, S., & Malattia, C. (2025) · Biomedicines · doi:10.3390/biomedicines13051168 · Cited by 7
Simons, L. E., Moayedi, M., Coghill, R. C., Stinson, J., Angst, M. S., Aghaeepour, N., Gaudilliere, B. L., King, C. D., López‐Solà, M., Hoeppli, M., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-061548 · Cited by 7
Complementary and Integrative Methods in Fibromyalgia
Ali, A., & McCarthy, P. L. (2014) · Pediatrics in Review · doi:10.1542/pir.35-12-510 · Cited by 6
Timmers, I., Biggs, E. E., Bruckert, L., Tremblay-McGaw, A. G., Zhang, H. G., Borsook, D., & Simons, L. E. (2024) · Pain · doi:10.1097/j.pain.0000000000003269 · Cited by 5
“[15;27;42;57] Despite the severe burden, our understanding of mechanisms underlying its development and persistence remains limited.”
The Influence of Loneliness on Pain Outcomes for Adolescents: A Cross-Sectional Survey
Forgeron, P. A., Stinson, J., Birnie, K. A., Finley, G. A., Jordan, A. L., Qualter, P., de Cândido, L. K., Lamont, M., Bradley, C., Linkiewich, D., et al. (2024) · Canadian Journal of Pain · doi:10.1080/24740527.2024.2404615 · Cited by 7
“47,48 Understanding how, or if, collective loneliness adds to chronic pain as a barrier for postsecondary education is essential.”
BackgroundWeiss, J. E., & Kashikar‐Zuck, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-78638-0_14 · Cited by 5
Self-citationBongi, S. M., Rosati, G. V., Bonaccorsi, G., & Lorini, C. (2023) · Biomedicines · doi:10.3390/biomedicines11061583 · Cited by 4
“In this regard, we observe that among children for whom the diagnosis of JFM has been delayed, the pain in the lower limbs is often interpreted as “growing pains” [8,24].”
BackgroundRoman‐Juan, J., Noel, M. E., Sharma, S., Jensen, M. P., Marbil, M. G., Birnie, K. A., & Miró, J. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105533 · Cited by 4
Crofford, L. J. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-31696-5.00052-8 · Cited by 4
Interdisziplinäre multimodale stationäre Schmerztherapie für junge Erwachsene
Schenk, S., Grothus, S., Genent, D., Selent, F., Zernikow, B., & Wager, J. (2019) · Der Schmerz · doi:10.1007/s00482-019-00417-0 · Cited by 4
Contents and delivery methods of pain neuroscience education in pediatrics: A scoping review
Rezende, J., Fernandes, L. A. P. P., Nogueira, L. A. C., Meziat‐Filho, N., Ickmans, K., & dos Reis, F. J. J. (2024) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2024.103182 · Cited by 4
Rheel, E., Craemer, M. D., Deliens, T., Pleysier, S., & Ickmans, K. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.104703 · Cited by 3
Sporttherapie in der pädiatrischen Rheumatologie
Milatz, F., & Hartmann, M. (2021) · Springer Reference Medizin · doi:10.1007/978-3-662-60411-3_72-1 · Cited by 3
Alslman, E. T., Thultheen, I. N., Hamaideh, S. H., Nofal, B., Hamdan-Mansour, R. A., & Hamdan‐Mansour, A. M. (2023) · Mental Health and Social Inclusion · doi:10.1108/mhsi-09-2023-0096 · Cited by 3
Martín-Herrero, L., Suñol, M., Pascual‐Diaz, S., Ting, T. V., Dudley, J. A., Jackson, C., Kashikar‐Zuck, S., Coghill, R. C., & López‐Solà, M. (2025) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsaf060 · Cited by 4
Self-citationBrain predictors of multisite pain onset in children
López‐Solà, M., Suñol, M., & Timmers, I. (2021) · Pain · doi:10.1097/j.pain.0000000000002430 · Cited by 3
Kallesøe, K. H., Ørnbøl, E., Wellnitz, K. B., & Rask, C. U. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2521719 · Cited by 3
“Furthermore, there is a significant risk of symptom continuity with associated lower educational attainment (Horst et al., 2014; Kashikar-Zuck et al., 2014) and high health care costs (Graesholt-Knudsen et al., 2017; Saunders et al., 2020).”
The Challenges of Identifying Fibromyalgia in Adolescents
Peterson, E. E., Yao, C., Sule, S., & Finkel, J. C. (2022) · Case Reports in Pediatrics · doi:10.1155/2022/8717818 · Cited by 3
“FM is a noninflammatory disorder of the nervous system characterized by widespread musculoskeletal pain and somatic complaints of at least 3 months duration [4]; juvenileonset fibromyalgia carries a greater burden of psychological and functional impairment when compared to adult-onset fibromyalgia [5].”
BackgroundSchmerzerkrankungen des Bewegungsapparates im Kindes- und Jugendalter
Gerhold, K. (2022) · Springer Reference Medizin · doi:10.1007/978-3-662-60410-6_68 · Cited by 2
Schults, J. A., Paterson, R., Cooke, M. L., Richards, J., Charles, K. R., Raithatha, B., Theodoros, J., & Alcock, M. (2021) · Journal of Child Health Care · doi:10.1177/13674935211026124 · Cited by 1
“To measure emotional functioning study authors used numerous tools including the Children’s Depression Inventory (three studies) and Pediatric Pain Coping Inventory (three studies).”
BackgroundMethodInfluential
Metadata
- Authors
- Kashikar-Zuck, S., Cunningham, N., Sil, S., Bromberg, M. H., Lynch-Jordan, A. M., Strotman, D., Peugh, J., Noll, J., Ting, T. V., Powers, S. W., Lovell, D. J., & Arnold, L. M.
- Affiliations
- Divisions of Behavioral Medicine and Clinical Psychology and
- Pennsylvania State University (US)
- Cincinnati Children's Hospital Medical Center (US)
- University of Cincinnati (US)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2014-03-01
- Volume
- 133
- Issue
- 3
- Pages
- e592-e600
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC3934334
- OpenAlex
- W2044719167
- Cited by
- 135
- References
- 51
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 21 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 12 · 2016: 15 · 2015: 11 · 2014: 5
- FWCI
- 10.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR001425)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR054842, K24AR056687)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Hematology › Autoimmune and Inflammatory Disorders Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- fibromyalgia, adolescents, early adulthood, long-term outcomes, chronic pain, physical function, anxiety, depressive symptoms, health care utilization, educational attainment, marital status, transition to adult care
- MeSH terms
- Adolescent, Age Factors, Child, Depression, Female, Fibromyalgia, Follow-Up Studies, Humans, Male, Pain Measurement, Prospective Studies, Socioeconomic Factors, Time Factors, Cohort Studies, Treatment Outcome, Young Adult
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