juvenile fibromyalgia

THE LOWDOWN ON
JUVENILE FIBROMYALGIA

Adding to this, the Standard American Diet (SAD) is beyond poor.  The average person is living on nutritionally depleted, chemically laden, lacking in fiber and water, sugar loaded food, (if you can call it food) that is so ridiculously unhealthy that I am actually starting to see teenagers with Fibromyalgia symptoms.”  Dr. Russell Schierling from 2011’s piece on Drenamin.

There is little evidence to support pure pharmacological management of JFM, particularly as a long-term solution.”  From the article in this month’s issue of Practical Pain Management — a journal by pain doctors for pain doctors (Long-Term Outcomes and New Developments in Juvenile Fibromyalgia) by Drs. Susan Tran, Tracy Ting, and Susmita Kashikar-Zuck.

I truly enjoy Practical Pain Management because it not only educates me about some of the more common conditions that cause Chronic Pain (this article said that as many as 6% of all American school-aged children have JFM, otherwise known as Juvenile Fibromyalgia), but gave me some insight into how treating physicians think.  Unfortunately, this article reinforces what I have been saying for a very long time — that the gap between the academic / research side of medicine and the day-to-day practice of medicine is less like a gap and more like the GRAND CANYON.    You’ll see what I mean shortly.

Fibromyalgia shares many of the same symptoms as does JFM.  According to this article, the list of health problems that are commonly seen in individuals with Juvenile Fibromyalgia includes

  • CHRONIC HEADACHES:  This can include MIGRAINE HEADACHES which I will discuss a bit more momentarily.
  • GASTROINTESTINAL PROBLEMS:  GI problems are almost ubiquitous in the Fibromyalgia population, and the main one seen is in JFM (not to mention Fibromyalgia) is IRRITABLE BOWEL SYNDROME.  However, various forms of INFLAMMATORY BOWEL DISEASE are not uncommon either.
  • WIDESPREAD MUSCULOSKELETAL PAIN AND STIFFNESS:  This is the most common sign / symptom and is actually how the disease is diagnosed.  By the way, 6% of our nation’s school kids roughly translates to three million.
  • MOOD DISORDERS:  ANXIETY AND DEPRESSION are the ones most commonly mentioned, but there are plenty of others, including things like Mania and Bipolar Disorder.
  • STRESS:  This is huge once you begin to get a handle on what “ADRENAL STRESS” is. And never forget that this stress can be mental, emotional, physical, or dietary.
  • COGNITIVE SYMPTOMS:  These are often loosely referred to as “Brain Fog” or even “Fibro Fog” and are characterized by things like forgetfulness and an inability to think clearly or make wise decisions.
  • SLEEP DISORDERS & INSOMNIA:  This is fairly self explanatory.
  • FATIGUE:  People with the “Chronic Fatigue” aspect of Fibromyalgia are often exhausted, yet as the bullet point above implies, cannot sleep.
  • DYSAUTONOMIA:  Dysautonomia is a type of Neuropathy that is characterized by shortness of breath, bladder / bowel / digestive problems, difficulty regulating heart rate or blood pressure, heat intolerance and / or SEXUAL DYSFUNCTION.  Many of the problems on this entire list will be found under a heading called SYMPATHETIC DOMINANCE.
Although the authors ask the question, “what causes JFM?,” they never really give us an answer, but instead discuss what it is (or at least what they think it is).  Although they talk about things like “ramped up pain perception / heightened sensitivity to pain /  descending inhibition of pain (central sensitization),” they never really tell us why certain people develop Fibromyalgia.  The chief culprit that these authors attribute JFM to is something called “SMALL FIBER POLYNEUROPATHY.  As proof they offer up a 2013 study from the journal Pediatrics (Evidence of Small-Fiber Polyneuropathy in Unexplained, Juvenile-Onset, Widespread Pain Syndromes) which reveals that 98% of the adolescents looked at who were dealing with the sort of widespread pain seen in those suffering from JFM either had “definite or probable” Neuropathy.

I will admit that this article pays more than lip service to therapies other than drugs.  Some of the non-pharmacological treatments specifically mentioned in this paper include things like, “Physical Therapy, Cognitive Behavioral Therapy (CBT), cognitive skills (identifying thoughts and feelings), regular physical exercise aerobic exercise, brisk walking, swimming, sports, strength training, stress management, relaxation skills, improved sleep hygiene, pacing activities, problem solving, deep muscle relaxation, guided imagery, restructuring skills, identifying maladaptive thought patterns about pain, targeting maladaptive thought patterns related to pain and functioning, massage, yoga, and acupuncture, neuromuscular training programs, coping skills,” etc, etc…………..  Some of these they readily admit are more effective than others.  But here’s the rub.

However, they also admit that, “it is important for interventions to be interdisciplinary and powerful enough to provide sustained effects.”  Great.  Who wouldn’t agree with this statement?  But let’s see how this idea is working out so far concerning the treatment of Juvenile Fibromyalgia (or for that matter, Fibromyalgia in general).  “Currently offered treatments are not very effective in reducing symptoms or their impact on function.”  Dis you catch that?  All of the time, money (much of it tax dollars), effort spent on non-drug treatment for JFM, and it neither helps their pain nor improves their ability to function for anything longer than “temporarily“.  This isn’t my conclusion, but the conclusion of the paper’s authors.  And it gets worse.  “Associated symptoms (eg, headache, disrupted sleep, irritable bowel symptoms, paresthesias) did not change over time, regardless of treatment modality or adherence to treatment…..  Symptoms of JFM continue into adulthood for the majority of patients.”   Sort of reminds me of the definition of “Insanity” —- continuing to do the same the same old things that never worked previously.

The authors go on to say that in order to effectively treat those with JFM, we will have to come up with, “novel interventions that target healthy lifestyle, and self-management techniques to provide sustained effects.  Interventions for JFM need to be more powerful than those currently available, and they also need to be long lasting.”  Novel interventions……  Hmmmm.   This brings me to the main two points of this post — the rampant use of drugs and the failure to mention nutritional therapy.

Despite all their posturing about drugs not being effective treatment for those with JFM, discussing their use certainly seems to take up a significant part of the paper.  The authors tell us several times that, “There is limited support for medications for treating JFM. Medications may play a role in the management of JFM symptoms; however, they do not provide long-term solutions. This statement is a tautology.  The only conceivable reason that a physician would prescribe drugs for someone with Fibromyalgia in the first place would be to diminish symptoms (this is because they all know that the list of drugs I am going to show you are strictly palliative and not therapeutic).  In other words, drugs may (temporarily at least) cover symptoms but never get to the root causes of those symptoms. 

Below is the specific list of drugs mentioned in this paper.  The authors themselves (physicians and Ph.D researchers) are not necessarily endorsing all of these various pharmacological agents.  They are reporting them as options, reporting them as currently being researched for potential effectiveness at relieving symptoms, or are telling us that they are already widely in use at the present time.

  • CORTICOSTEROIDS:  If you want the lowdown on CORTICOSTEROIDS, take a moment to click the link and read.
  • IMMUNOGLOBULIN THERAPY:   I don’t know much about this because to the best of my knowledge, none of my patients have ever gone through it.
  • SSRI ANTIDEPRESSANTS:  Duloxetine and Fluoxetine were the ones specifically mentioned.  Click on the link to learn why ANTIDEPRESSANTS are some seriously bad drugs.
  • NSAIDS:  HERE is an article I wrote just the other day about this class of drug.
  • PREGABLIN:   (LYRICA) — second generation Neurontin.
  • TRAMADOL:  A pain medication.
  • SLEEP AIDS:  Melatonin and Amitrptline were mentioned by name.
  • MUSCLE RELAXERS:  Cyclobenzaprine and other MUSCLE RELAXERS are bad news as well.
  • ORAL CONTRACEPTIVES:  Dysmenorrhea (abnormal periods — also heavily associated with PCOS) is one of the common female-specific complaints associated with JFM.
  • HEADACHE MEDICINE:  None is specifically mentioned by name, but there are about a jillion of them.
  • MEDICATION FOR IRRITABLE BOWEL SYNDROME:  None is specifically mentioned by name, but there are several.

Furthermore, we learn that even though the authors state that, opioids are not recommended for JFM management, given limited efficacy and the potential addiction risks associated with chronic use,” most physicians are not following their own standards of care. What do I mean by this?  In an article in the same issue of of the very same journal (Are Opioids Being Overprescribed For Fibromyalgia?), author, Elizabeth Masters of PFIZER’S Global Health Economics & Outcomes Research division comes to the same conclusions.  Listen to her shocking admission in a report given back in September in Phoenix to the physicians who attended the annual meeting of the American Academy of Pain Management.

Although evidence-based guidelines do not recommend opioids as first-line therapy for newly diagnosed fibromyalgia patients, these agents remain the most frequently prescribed medication for this population, accounting for 59% of prescriptions….   The investigators found that opioids were the most frequently prescribed first medication.

Gulp!  I’ll not belabor this point, but this is yet another of the infinite examples that strike at the very heart of what we erroneously refer to as “EVIDENCE-BASED MEDICINE“.  People with Fibromyalgia are not supposed to be given NARCOTICS. Period.  But nearly 6 out of 10 are.  In light of THIS STUDY, it certainly makes one wonder just how many children are being given opioids for their Juvenile Fibromyalgia.

Earlier I shared with you that there were two reasons that this paper left me troubled.  I just dealt with the first.  So before we leave, I have to discuss the second — the authors failure to discuss diet as a potential therapy.  That’s right; diet was not as much as mentioned in any form in this paper — good, bad, or otherwise, as a therapy (valid or not) for JFM.  In other words, these authors don’t tell those suffering from JFM to stay away from sugar or junk.  Nor do they even hit us with that frequently given (generic) admonition to “eat healthy“.  Nothing.  Nada.  Zilch.  Zero. Zip.  The silence on this issue is deafening. 

Are we supposed to believe that the horrendous diets of our nation’s young people has no effect on them developing Fibromyalgia — particularly when you begin to understand how SUGAR and refined carbs burn out the ENDOCRINE SYSTEM, and most particularly the PANCREAS and ADRENAL GLANDS?  I have seen reports saying that teenagers are, on average, getting half of their daily calories from SODA.   The whole thing reminds me of the way that many doctors still deny the link between Sugar and ADD / ADHD.   Where does it end?

We know for a fact that when it comes to Fibromyalgia, some of the most commonly seen symptoms are Migraine Headaches, Depression, and IBS (there are links to all three earlier on the page).  Not only are all three intimately related to GUT HEALTH, but all three are intimately related to GLUTEN SENSITIVITY as well.  Oh; and by the way, so is NEUROPATHY — the very thing that experts are coming to the conclusion that Fibromyalgia is a form of.  This is why many have said for a very long time that Fibromyalgia is another of the multitude of AUTOIMMUNE DISEASES (HERE is a list of a few of them) descending on us like a plague of biblical proportions. 

So; if I suspected my child had Juvenile Fibromyalgia, what would I do?   I would start by following the protocol found HERE.  No, it’s not going to be the solution to every case of Fibromyalgia or Juvenile Fibromyalgia for that matter.  However, it will be a good starting point, and provide you with a great deal of invaluable information.

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