Lynch-Jordan AM, Sil S, Bromberg M, Ting TV, Kashikar-Zuck S. Cross-sectional study of young adults diagnosed with juvenile fibromyalgia: Social support and its impact on functioning and mood. J Adolesc Health. 2015 Nov;57(5):482-7.
This paper is from the third wave of our longitudinal study on juvenile fibromyalgia, with participants who are now in their early 20’s, about six years after initial participation in the study. It investigates the differences in social support and social networks between young adults previously diagnosed with JFM compared to healthy controls. Notably, social support variables predicted key factors of physical functioning and depressive symptoms, which likely need addressed as aspects of early interventions for these youth.
Kroner JW, Hershey AD, Kashikar-Zuck SM, LeCates SL, Allen JR, Slater SK, Zafar M, Kabbouche MA, O'Brien HL, Shenk CE, Rausch JR, Kroon Van Diest AM, Powers SW. Cognitive behavioral therapy plus amitriptyline for children and adolescents with chronic migraine reduces headache to ≤4 per month. Headache. 2016 Apr;56(4):711-6.
This analysis of our clinical trial published in JAMA in 2013 is the first report in the field of headache medicine (including adult studies) to systematically test whether CBT can produce such robust results that clinicians would say the outcome indicates no further prevention treatment would be needed. To go from about five headache days per week to one or less per week is something we considered to be of very significant clinical impact. Seven out of 10 patients treated with CBT plus amitriptyline evidenced this result at our 12 month follow-up. The implications are that clinicians may now have overwhelming evidence to change practice, such that CBT is always prescribed as a first line treatment for youth with chronic migraine. Feedback from the American Headache Society membership (the primary readership of Headache) indicates that these data have led to having CBT discussed with all patients diagnosed with chronic migraine. In this way, we see this paper as fundamentally impacting the current practice of headache medicine in the United States and across the world given the high prevalence of migraine in youth (about 12% of all children and adolescents).
Ting TV, Barnett K, Lynch-Jordan A, Whitacre C, Henrickson M, Kashikar-Zuck S. 2010 American College of Rheumatology adult fibromyalgia criteria for use in an adolescent female population with juvenile fibromyalgia. J Pediatr. 2016 Feb;169:181-7.
The included editorial written by Dr. David Sherry, from Children's Hospital of Philadelphia, summarizes why this is important to the field of Pediatrics. Juvenile fibromyalgia (JFM) is a poorly recognized condition in adolescents. Pediatricians and pediatric rheumatologists have so far had no validated criteria to use for the classification of this disorder. As a result, these children often receive a large number of unnecessary tests, multiple visits to specialists and poor medical management of their pain. Adolescents with JFM have a very poor quality of life, psychosocial difficulties, and are functionally disabled in many aspects of their lives. Clinical research (as well as proper clinical care) has been hampered by the lack of consistent criteria and resulting unwillingness of physicians to make this diagnosis. This initial study on JFM criteria for the first time offers the pediatric community the option of applying criteria suggested by the American College of Rheumatology for adult fibromyalgia in pediatric patients. Our study has led to a new tool which we will test in a large national study of adolescents with chronic pain for further validation and refinement and sets the stage for more systematic study of this highly disabling and poorly treated condition.
Ryan JL, McGrady ME, Guilfoyle SM, Follansbee-Junger K, Arnett AD, Modi AC. Health care charges of youth newly diagnosed with epilepsy. Neurology. 2015 Aug;85(6):490-7.
This is the first paper that examined healthcare charges in pediatric epilepsy, which are approximately $20,084 in the first year. Higher charges are typical for patients with a higher number of seizures since diagnosis, which is not surprising. However, poor baseline health-related quality of life was also a significant predictor of higher per patient healthcare charges. This paper also found that integrating behavioral medicine visits in routine epilepsy care did not significantly affect healthcare charges. Overall, these results highlight that health-related quality of life is an important predictor of healthcare charges, an outcome that is amenable to behavioral intervention. Thus, the role of behavioral medicine in pediatric epilepsy is not only critical for psychosocial care but could potentially reduce charges in the future. Notably, this paper was a synergy across clinicians and researchers in the Division of Behavioral Medicine and Clinical Psychology.