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Juvenile fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference. Participants were 203 adolescents (ages 12–17 years) who completed baseline assessments for the multisite Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool, which includes a Widespread Pain Index (WPI; 0–18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0–12) based on the 2010 American College of Rheumatology criteria for fibromyalgia. Participants also completed self‐report measures of pain intensity, functional impairment, and psychological functioning. Participants endorsed a median of 11 painful body sites (WPI score) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterologic, and psychological symptoms were frequently endorsed. The WPI score was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment. JFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors, highlighting the need for a broader approach to the assessment and treatment of JFM.

Despite the increasing popularity of e-cigarettes, their long-term health effects remain unknown. In animal models, exposure to e-cigarette has been reported to result in pulmonary and cardiovascular injury, and in humans, the acute use of e-cigarettes increases heart rate and blood pressure and induces endothelial dysfunction. In both animal models and humans, cardiovascular dysfunction associated with e-cigarettes has been linked to reactive aldehydes such as formaldehyde and acrolein generated in e-cigarette aerosols. These aldehydes are known products of heating and degradation of vegetable glycerin (VG) present in e-liquids. Here, we report that in mice, acute exposure to a mixture of propylene glycol:vegetable glycerin (PG:VG) or to e-cigarette-derived aerosols significantly increased the urinary excretion of acrolein and glycidol metabolites─3-hydroxypropylmercapturic acid (3HPMA) and 2,3-dihydroxypropylmercapturic acid (23HPMA)─as measured by UPLC-MS/MS. In humans, the use of e-cigarettes led to an increase in the urinary levels of 23HPMA but not 3HPMA. Acute exposure of mice to aerosols derived from PG:13C3-VG significantly increased the 13C3enrichment of both urinary metabolites 13C3-3HPMA and 13C3-23HPMA. Our stable isotope tracing experiments provide further evidence that thermal decomposition of vegetable glycerin in the e-cigarette solvent leads to generation of acrolein and glycidol. This suggests that the adverse health effects of e-cigarettes may be attributable in part to these reactive compounds formed through the process of aerosolizing nicotine. Our findings also support the notion that 23HPMA, but not 3HPMA, may be a relatively specific biomarker of e-cigarette use.

Children with acute recurrent and chronic pancreatitis experience severe abdominal pain that may be intermittent or chronic. Pain is often debilitating, causing interference with academic, social, family, and extracurricular activities that are important to youth. Disruption of these routines and the unpredictability of pain flares place children with pancreatitis at increased risk for development of anxious or depressive symptoms. Pediatric psychologists trained in cognitive-behavioral treatment are well suited to intervene on functional disability and mood disturbance, as well as teach coping skills. In an era where there is movement away from opioids, nonpharmacological strategies have an important place for pain management. In fact, positive outcomes following for children with other recurrent abdominal pain syndromes have been reported for this evidence-based intervention. In addition to pain management, pediatric psychologists can address other co-occurring behavioral and emotional problems in children with pancreatitis, such as needle phobia and poor adherence to the prescribed medical regimen.

To examine the differential presentation(s) of psychological and health‐related outcomes in young adults with juvenile‐onset fibromyalgia (FM) with and without a history of trauma, compared to healthy controls. In total, 110 participants (86 with juvenile‐onset FMand 24 healthy controls, with a mean age of 23.4 years) completed a structured clinical interview to assess for trauma and psychological comorbidities, as well as self‐report questionnaires on pain, physical functioning, and health care utilization. Of the juvenile‐onset FMparticipants, 37% (n = 32) reported a history of trauma. Three group comparisons (i.e., juvenile‐onset FMwith trauma versus juvenile‐onset FMwith no trauma versus healthy controls) revealed that juvenile‐onset FMparticipants significantly differed from healthy controls on all psychological and health‐related outcomes. Further, although juvenile‐onset FMparticipants with and without a history of trauma did not significantly differ on pain and physical functioning, juvenile‐onset FMparticipants with a history of trauma were significantly more likely to have psychological comorbidities. This is the first controlled study to examine the differential outcomes between juvenile‐onset FMparticipants with and without a history of trauma. Group comparisons between juvenile‐onset FMparticipants and healthy controls were consistent with previous research. Further, our findings indicate that juvenile‐onset FMparticipants with a history of trauma experience greater psychological, but not physical, impairment than juvenile‐onset FMparticipants without a history of trauma.

For a large portion of youth, pain-associated functional gastrointestinal disorders (FGIDs) are associated with significant impairment over time. Clinically feasible methods to categorize youth with FGIDs at greatest risk for persistent pain-related impairment have not yet been identified. Measures of functional disability, pain intensity, and anxiety were collected on 99 patients with FGIDs (ages 8–18) during a visit to a pediatric gastroenterology office to assess for the presence of risk. Follow-up data were obtained on a subset of this sample (n = 64) after 6 months, either in person or via mail. The present study examined whether a greater number of risk factors at baseline predicted greater pain-related disability at follow-up. Patients were divided into 4 groups based on number of risk factors present at the initial assessment: 0 (18.2%), 1 (24.2%), 2 (26.3%), and 3 (31.3%). The presence of 2 or 3 risk factors significantly predicted greater disability at follow-up compared to those with 0 risk factors (R2= 0.311) and those with just 1 risk factor (Cohen's dvalues of –1.07 and –1.44, respectively). A simple approach to risk categorization can identify youth with FGIDs who are most likely to report increased levels of pain-related impairment over time. These findings have important clinical implications that support the utility of a brief screening process during medical care to inform referral for targeted treatment approaches to FGIDs.

To describe protocol adaptations to the Fibromyalgia Integrative Training for Teens (FIT Teens) randomized controlled trial in response to the COVID-19 pandemic. The overarching aims of the FIT Teens multi-site 3-arm comparative effectiveness trial are to assess whether a specialized neuromuscular exercise training intervention combined with cognitive-behavioral therapy (CBT) is superior to CBT alone or graded aerobic exercise alone.

The primary outcome in many treatment studies for pediatric chronic pain has been reduced pain intensity, but it is well documented that several facets of chronic pain, including poor coping and functional disability, negatively impact daily functioning and mood. Given recent attention to defining and collecting evidence-based clinical outcomes, it is important to develop feasible methods of measuring these behavioral outcomes in clinical settings. This article describes the process of translating empirically derived measures of pain intensity, pain coping efficacy, and functional disability into clinical practice and provides a first step toward developing an indicator for classifying “positive treatment response” for patients completing a course of cognitive–behavioral therapy (CBT) for pain management. Patients (n= 100, ages 8–18 years) completed outcome measures of disability, coping, and pain intensity during every CBT treatment session. A treatment response indicator was created to represent a positive treatment response to CBT appropriate for clinical settings: 25% decrease in disability OR 40% increase in pain coping efficacy OR 30% decrease in pain intensity at the end of active treatment. Results showed that 75% of patients met criteria for a positive treatment response. Specifically, 60% achieved a 25% reduction in FDI, 34% ended active treatment with a 40% or greater increase in pain coping efficacy, and 44% achieved a 30% reduction in average pain intensity. This study describes the process of using outcome measures to measure positive treatment response in pediatric behavioral pain management.

Functional abdominal pain (FAP) is associated with significant anxiety and impairment. Prior investigations of child anxiety in youth with FAP are generally limited by small sample sizes, based on child report, and use lengthy diagnostic tools. It is unknown whether a brief anxiety-screening tool is feasible, whether parent and child reports of anxiety are congruent, and whether parent and child agreement of child anxiety corresponds to increased impairment. The purpose of this investigation was to examine anxiety characteristics in youth with FAP using parent and child reports. Parent–child agreement of child anxiety symptoms was examined in relation to pain and disability.

Functional abdominal pain (FAP) is associated with significant anxiety and impairment. Prior investigations of child anxiety in youth with FAP are generally limited by small sample sizes, based on child report, and use lengthy diagnostic tools. It is unknown whether a brief anxiety-screening tool is feasible, whether parent and child reports of anxiety are congruent, and whether parent and child agreement of child anxiety corresponds to increased impairment. The purpose of this investigation was to examine anxiety characteristics in youth with FAP using parent and child reports. Parent–child agreement of child anxiety symptoms was examined in relation to pain and disability. One hundred patients with FAP (8–18 years of age) recruited from pediatric gastroenterology clinics completed measures of pain intensity (Numeric Rating Scale) and disability (Functional Disability Inventory). Patients and caregivers both completed a measure of child anxiety characteristics (Screen for Child Anxiety and Related Disorders). Clinically significant anxiety symptoms were more commonly reported by youth (54%) than their parents (30%). Panic/somatic symptoms, generalized anxiety, and separation anxiety were most commonly endorsed by patients, whereas generalized anxiety, separation anxiety, and school avoidance were most commonly reported by parents. The majority (65%) of parents and children agreed on the presence (26%) or absence (39%) of clinically significant anxiety. Parent–child agreement of clinically significant anxiety was related to increased impairment. A brief screening instrument of parent and child reports of anxiety can provide clinically relevant information for comprehensive treatment planning in children with FAP.

Objective.Adolescents with juvenile-onset fibromyalgia (JFM) have increased rates of psychiatric disorders, but to our knowledge no studies have examined psychiatric disorders in adolescents with JFM when they enter young adulthood. This study examined the prevalence of psychiatric disorders in young adults diagnosed with JFM during adolescence and the relationship between mental health diagnoses and physical functioning.Methods.Ninety-one young adults (mean age 21.60, SD 1.96) with a history of JFM being followed as part of a prospective longitudinal study and 30 matched healthy controls (mean age 21.57, SD 1.55) completed a structured interview of psychiatric diagnoses and a self-report measure of physical impairment.Results.Young adults with a history of JFM were more likely to have current and lifetime histories of anxiety disorders (70.3% and 76.9%, respectively) compared with controls (33.3% for both, both p < 0.001). Individuals with JFM were also more likely to have current and lifetime histories of major mood disorders (29.7% and 76.9%, respectively) compared with controls (10% and 40%, p < 0.05). The presence of a current major mood disorder was significantly related to impairment in physical functioning [F (1, 89) = 8.30, p < 0.01] and role limitations attributable to a physical condition [F (1, 89) = 7.09, p < 0.01].Conclusion.Psychiatric disorders are prevalent in young adulthood for individuals with a history of JFM, and a current major mood disorder is associated with greater physical impairment. Greater attention to early identification and treatment of mood disorders in patients with JFM is warranted.

Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning, and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors (overprotection, minimizing, and/or encouragement) in response to their child's pain interact with child coping characteristics (eg, catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relation between parenting factors and child disability would be mediated by children's levels of maladaptive coping (ie, pain catastrophizing). Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated in the study. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: Protection, Minimizing, and Encouragement/Monitoring subscales). Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relation between parent encouragement/monitoring and disability and partially mediated the relation between parent protectiveness and disability. The impact of parenting behaviors in response to FAP on child disability is determined, in part, by the child's coping style. Findings highlight a more nuanced understanding of the parent–child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP.

Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning, and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors (overprotection, minimizing, andor encouragement) in response to their child's pain interact with child coping characteristics (eg, catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relation between parenting factors and child disability would be mediated by children's levels of maladaptive coping (ie, pain catastrophizing).

Functional abdominal pain (FAP) is a common pediatric disorder associated with impairment in functioning that may persist for the long term. Anxiety is common in youth with FAP, and may be an important factor in predicting youth who are at greatest risk for increased impairment because of pain symptoms. In this article, we examine the relation between anxiety and impairment in youth with FAP. Furthermore, we explore various biopsychosocial factors (eg, neurobiological substrates, coping strategies, social factors) that may be implicated in the relation among FAP, anxiety, and increased impairment. Finally, we propose physician guidelines for screening and treatment of youth with FAP and co-occurring anxiety. Youth with FAP and co-occurring anxiety may benefit from cognitive-behavioral therapy in the context of multidisciplinary care.

Functional abdominal pain (FAP) is a common pediatric disorder associated with impairment in functioning that may persist for the long term. Anxiety is common in youth with FAP, and may be an important factor in predicting youth who are at greatest risk for increased impairment because of pain symptoms. In this article, we examine the relation between anxiety and impairment in youth with FAP. Furthermore, we explore various biopsychosocial factors (eg, neurobiological substrates, coping strategies, social factors) that may be implicated in the relation among FAP, anxiety, and increased impairment. Finally, we propose physician guidelines for screening and treatment of youth with FAP and co-occurring anxiety. Youth with FAP and co-occurring anxiety may benefit from cognitive-behavioral therapy in the context of multidisciplinary care.

Juvenile Fibromyalgia (JFM) is a widespread, disabling pain condition that is inconsistently conceptualized and classified compared to adult fibromyalgia (FM). The aim of this study was to comprehensively phenotype JFM in a pediatric population using a representative sample of adolescents from a multi-site JFM clinical trial and evidence-based measures of functional and psychosocial outcomes. Participants were 203 adolescents (12-17 years) diagnosed with JFM based on 2010 ACR FM criteria, verified by the Pain and Symptom Assessment Tool (PSAT) adapted for adolescents. The PSAT yields information on pain locations (Widespread Pain Index; WPI) and presence and intensity of somatic symptoms (Symptom Severity (SS) scale). Participants also completed self-report measures of pain intensity, functional disability, pain interference, fatigue and depression as part of baseline assessment in an ongoing clinical trial. Participants endorsed moderate pain intensity (M = 5.9), a median of 11 (of 18) pain locations (WPI), and a median score of 9 (of 12) on the SS scale. Specifically, they reported an average of 12 (of 24) somatic symptoms, which were primarily neurological/autonomic symptoms. The cardinal symptoms of fatigue and nonrestorative sleep were endorsed frequently as a moderate or severe problem (85%), which was corroborated by self-report fatigue ratings (PROMIS Fatigue) that were two standard deviations above the mean. Correlations between the WPI, SS scale, and outcome measures showed the WPI was significantly associated with pain intensity only. However, the SS scale was significantly correlated with pain intensity, fatigue, functional disability, pain interference, and depressive symptoms. JFM appears to be closely aligned with the adult manifestation of FM. Comorbid somatic symptoms associated with JFM require further study to understand their unique contribution to functioning and coping. The PSAT appears useful for assessing pain locations and symptom severity and may help more systematically identify and characterize JFM. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) of the National Institutes of Health award numbers U34AR067978 and R01AR070474 (PI: Kashikar-Zuck) Clinical trials.gov Registration: NCT 03268421.