Quality of life and emotional functioning in youth with chronic migraine and juvenile fibromyalgia.

Chronic pain in children and adolescents is a significant public health problem with over 25% of school-age children reporting recurrent or chronic pain.1 The impact of chronic pain on social and emotional functioning has been studied in various pediatric pain conditions2-10. Results from these studies suggest lower overall functioning in children and adolescents with chronic pain conditions when compared to their healthy counterparts but less is known about how children with the various chronic pain syndromes differ from one another. Most of the aforementioned research studies examining the impact of pediatric pain have focused on either combined samples of various pain conditions or on single conditions in isolation such as abdominal pain, fibromyalgia, or headache. Research on combined pain conditions is limited by relatively small sample sizes for each pain subtype. Similarly, functioning examined in a single pain condition may not generalize to other pain syndromes; therefore, little is known about the potential similarities and differences between various pediatric chronic pain conditions in terms of social and emotional functioning. Results from a recent study suggested that children and adolescents with recurrent headache may have lower levels of disability and depressive symptoms compared to those with widespread musculoskeletal pain. 11 However, a limitation of the study was that classification of pain subtypes was designated based on primary pain location only and not based on clear medical diagnoses based on specific diagnostic criteria. Despite the relative paucity of research on sub-groups of pediatric pain conditions, clinicians anecdotally report distinct differences in patients with various chronic pain syndromes such as greater impairment in those with widespread musculoskeletal pain compared to other pain conditions. It is plausible that chronic pain may have differential impact depending on underlying pathophysiology, specific pain characteristics such as pain location, frequency, and severity, or presence of comorbid somatic symptoms or mood difficulties. The reasons why different pain conditions may result in greater or lesser impact on children's daily lives is as yet poorly understood, yet this topic has important implications for treatment planning. As an initial step, more empirical work is needed to identify areas of commonalities and differences between pain conditions in children, even as science into the underlying biological mechanisms of chronic pain and associated symptoms advances our understanding of specific pain conditions. Juvenile Fibromyalgia (JFM) and pediatric Chronic Migraine (CM) are two chronic pain syndromes that have several common elements including persistent or recurrent pain that occurs daily or almost daily. Research on adults has shown that fibromyalgia and migraine headaches share some overlapping features 12-14 including similar neurobiological changes associated pain hypersensitivity 15,16. However, adult fibromyalgia patients experience poorer quality of life (QOL) compared to those with migraine headaches 14. Similar to adult fibromyalgia, JFM in children is characterized by constant widespread pain, fatigue, and sleep disturbance, along with multiple associated somatic symptoms. JFM patients also appear to have substantially higher rates of anxiety and mood disturbances 17 than children with CM 18 but there are no studies comparing QOL differences in the two conditions . Treatment regimens for both chronic pain conditions typically consists of medication management and often recommendations for non-drug interventions (e.g., cognitive-behavioral therapy, lifestyle changes) to promote self-management and coping. A greater understanding of the impact of these pain subtypes would help inform more tailored approaches specific to their needs. As part of the screening procedure for two ongoing clinical research studies we obtained extensive information about pain characteristics, quality of life, and emotional functioning for over 300 patients who met diagnostic criteria for pediatric CM or JFM. The objective of the current study was to compare pain characteristics, quality of life and emotional functioning (depressive and anxiety symptoms) between patients with CM and those with JFM from the combined samples from these relatively large pediatric studies. Based on prior findings, we expected the CM and JFM groups to be similar in terms of pain intensity. However, we hypothesized that quality of life and emotional functioning would be significantly poorer in children and adolescents diagnosed with JFM as compared to those with CM.11