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Quality of Life and Emotional Functioning in Youth With Chronic Migraine and Juvenile Fibromyalgia

Kashikar-Zuck, Susmita PhD*,†; Zafar, Marium PsyD*; Barnett, Kimberly A. BS*; Aylward, Brandon S. PhD*; Strotman, Daniel BA*; Slater, Shalonda K. PhD*,†; Allen, Janelle R. MS*; LeCates, Susan L. RN, MSN, CFNP; Kabbouche, Marielle A. MD†,‡; Ting, Tracy V. MD, MSc†,§; Hershey, Andrew D. MD, PhD, FAHS†,‡; Powers, Scott W. PhD, ABPP, FAHS*,†

doi: 10.1097/AJP.0b013e3182850544
Original Articles

Summary: Chronic pain in children is associated with significant negative impact on social, emotional, and school functioning. Previous studies on the impact of pain on children’s functioning have primarily used mixed samples of pain conditions or single pain conditions (eg, headache and abdominal pain) with relatively small sample sizes. As a result, the similarities and differences in the impact of pain in subgroups of children with chronic pain have not been closely examined.

Objective: To compare pain characteristics, quality of life, and emotional functioning among youth with pediatric chronic migraine (CM) and juvenile fibromyalgia (JFM).

Methods: We combined data obtained during screening of patients for 2 relatively large intervention studies of youth (age range, 10 to 18 y) with CM (N=153) and JFM (N=151). Measures of pain intensity, quality of life (Pediatric Quality of Life; PedsQL, child and parent-proxy), depressive symptoms (Children’s Depression Inventory), and anxiety symptoms (Adolescent Symptom Inventory-4—Anxiety subscale) were completed by youth and their parent. A multivariate analysis of covariance controlling for effects of age and sex was performed to examine differences in quality of life and emotional functioning between the CM and JFM groups.

Results: Youth with JFM had significantly higher anxiety and depressive symptoms, and lower quality of life in all domains. Among children with CM, overall functioning was higher but school functioning was a specific area of concern.

Discussion: Results indicate important differences in subgroups of pediatric pain patients and point to the need for more intensive multidisciplinary intervention for JFM patients.

Divisions of *Behavioral Medicine and Clinical Psychology


§Pediatric Rheumatology, Cincinnati Children’s Hospital Medical Center

Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH

Supported by National Institute of Arthritis and Musculoskeletal and Skin Diseases—NIAMS R01AR050028 (S.K.-Z.); National Institute of Neurological Disorders and Stroke—NINDS R01NS050536 (PI: S.W.P., Bethesda, MD). The authors declare no conflict of interest.

Reprints: Susmita Kashikar-Zuck, PhD, Division of Behavioral Medicine and Clinical Psychology, MLC 3015, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 (e-mail:

Received April 17, 2012

Accepted December 27, 2012

© 2013 by Lippincott Williams & Wilkins