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Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time

Kashikar-Zuck, Susmitaa,b,*; Cunningham, Natoshiaa,b; Peugh, Jamesa,b; Black, William R.b; Nelson, Sarahc,d; Lynch-Jordan, Anne M.a,b; Pfeiffer, Meganb; Tran, Susan T.e; Ting, Tracy V.a,f; Arnold, Lesley M.g; Carle, Adama,h; Noll, Jenniei; Powers, Scott W.a,b; Lovell, Daniel J.a,f

doi: 10.1097/j.pain.0000000000001415
Research Paper

Juvenile-onset fibromyalgia (JFM) is typically diagnosed in adolescence and characterized by widespread pain and marked functional impairment. The long-term impact of JFM into adulthood is poorly understood. The objectives of this study were to describe physical and psychosocial outcomes of youth diagnosed with JFM in early adulthood (∼8-year follow-up), examine longitudinal trajectories of pain and depressive symptoms from adolescence to young adulthood, and examine the impact of pain and depressive symptoms on physical functioning over time. Participants were 97 youth with JFM enrolled in a prospective longitudinal study in which pain symptoms, and physical and psychosocial functioning were assessed at 4 time points over approximately 8 years. At the time 4 follow-up (Mage = 24.2 years), the majority continued to suffer from pain and impairment in physical, social, and psychological domains. However, trajectories of pain and emotional symptoms showed varying patterns. Longitudinal analysis using growth mixture modeling revealed 2 pain trajectories (Steady Improvement and Rapid Rebounding Improvement), whereas depressive symptoms followed 3 distinct trajectories (Low-Stable, Improving, and Worsening). Membership in the Worsening Depressive symptoms group was associated with poorer physical functioning over time (P < 0.001) compared with the Low-Stable and Improving groups. This study offers evidence that although JFM symptoms persist for most individuals, pain severity tends to decrease over time. However, depressive symptoms follow distinct trajectories that indicate subgroups of JFM. In particular, JFM patients with worsening depressive symptoms showed decreasing physical functioning and may require more intensive and consistent intervention to prevent long-term disability.

Longitudinal trajectory analyses showed decreasing pain over time in juvenile-onset fibromyalgia. A worsening depressive symptom trajectory was associated with the poorest outcomes in adulthood.

aDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States

bDivision of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

cDepartment of Anesthesia, Pain and Perioperative Medicine, Boston Children's Hospital, Boston, MA, United States

dDepartment of Psychiatry, Harvard Medical School, Boston, MA, United States

eDepartment of Psychology, DePaul University, Chicago, IL, United States

fDivision of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

gDepartment of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, United States

hJames M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

iDepartment of Human Development and Family Studies, The Pennsylvania State University, Cincinnati, OH, United States

Corresponding author. Address: Division of Behavioral Medicine and Clinical Psychology, MLC 7039, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States. Tel.: (513) 636 6337; fax: (513) 636 0602. E-mail address: Susmita.Kashikar-Zuck@cchmc.org (S. Kashikar-Zuck).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received May 24, 2018

Received in revised form September 24, 2018

Accepted October 05, 2018

© 2019 International Association for the Study of Pain
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