Background:Virtual reality (VR) is a novel technology with implications for pain and sensory processing. VR may serve as a novel, scalable method to deliver clinically validated therapy for pain management as an alternative or adjunct to opioids for acute pain. Given that psychological factors and pain perception are both components of postoperative pain, it may also be beneficial to incorporate modalities that decrease anxiety, such as active relaxation and guided meditation with VR. Unfortunately, these therapies are not widely available due to multiple barriers. VR has the potential to deliver pain-reducing, psychologically based therapy to children, thereby enhancing multimodal analgesia and potentially decreasing opioid use. This study investigates the role of VR in reducing pain and anxiety after surgery. Given the substantial risks associated with opioid use, particularly in younger populations, alternative pain management strategies are crucial. Objective:The primary aim of this study was to evaluate the efficacy of VR as a nonpharmacological intervention for managing postoperative pain intensity, pain unpleasantness, anxiety, and opioid use in children and adolescents undergoing Nuss repair of pectus excavatum. Methods:A single-center, prospective, randomized, controlled trial was conducted at a tertiary care children's hospital and research center. Ninety children and adolescents (8-18 y) undergoing the Nuss procedure were randomized to guided relaxation or mindfulness VR (n=30) and distraction-based gaming VR (n=30), combined to form the VR group (n=60), and a control group using a passive 360° video (n=30). Patients received a 10-minute session on postoperative days 1 and 2. Pain intensity, pain unpleasantness, and anxiety were evaluated before and 0-, 15-, and 30-minute post-session. In-hospital pain scores, anxiety scores, and opioid use were collected. Results:Children and adolescents who participated in VR reported a significantly greater decrease in pain intensity from baseline (0.41, SE 0.23) compared with those in the 360° video group at 30 minutes (P=.04) before multiplicity adjustment but not after multiplicity adjustment. There were no significant differences in pain scores or opioid use between the VR and control groups on postoperative day 1 or 2, nor were there changes in pain unpleasantness or anxiety at any time after the intervention. Conclusions:Daily, 10-minute VR sessions provided some trends toward transient analgesic and anxiolytic effects, albeit none that were statistically significant. VR did not significantly decrease overall pain scores or opioid usage, possibly due to the limited intervention duration and high standardized opioid use. Future studies should investigate extended and more frequent VR sessions and the integration of VR with other therapeutic modalities.

BACKGROUND:Traditional rehabilitation measures, such as the Functional Independence Measure for Children (WeeFIM II), designed to measure the need for assistance and severity of disability in children with developmental disabilities, may not be an optimal indicator of physical function among pediatric patients with chronic pain undergoing rehabilitation. A better understanding of the ability of physical outcome measures to detect change over time would improve evaluation of patient response to pain interventions such as intensive interdisciplinary pain treatment (IIPT). OBJECTIVE:To investigate the responsiveness to intervention of commonly used functional assessments among pediatric patients with pain undergoing IIPT. DESIGN:This retrospective cohort study collected self-reported and performance-based measures at admission and discharge from an IIPT program. The institutional review board approved study procedures. SETTING:IIPT program in an inpatient pediatric rehabilitation unit at a major midwestern children's hospital in the United States. PARTICIPANTS:Demographics and clinical outcomes from 210 patients admitted between January 2014 and December 2022 were abstracted from the medical record. Patients were 9-19 years old (average age = 15), 75% were female, and 91% were White. The most common diagnosis was amplified musculoskeletal pain syndrome (26%). INTERVENTIONS:Patients attended an IIPT program for an average of 17 days and completed measures at admission and discharge. MAIN OUTCOME MEASURES:Four performance-based measures, WeeFIM II, Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), 30-second step test (30SST), grip strength, and 6-minute walk test (6MWT), and one self-report measure, Canadian Occupational Performance Measure (COPM). RESULTS:Self-reported COPM and performance-based 6MWT and 30SST scores showed the greatest responsiveness to intervention. The WeeFIM II and BOT-2 scores were the least responsive to intervention. CONCLUSIONS:The COPM, 6MWT, 30SST were the most responsive measures to intervention, capturing improvement among children with chronic pain completing an IIPT program; the WeeFIM II and BOT-2 were the least responsive measures to intervention for this population.

Introduction:The number of clinical trials of extended reality (XR), including virtual and augmented reality, for pain has exponentially increased in the past 2 decades. To synthesize findings across studies and assess the effectiveness of XR interventions, a core outcome set (COS) is needed. Prior work identified 7 core outcome domains for XR trials in pain through a systematic review and consensus process. Objectives:The aim of this study was to establish a finalized COS of outcome measures (adult and pediatric) for XR trials for pain (acute, recurrent, and chronic). Methods:First, potential outcome measures were identified for each core domain through literature reviews. Second, a Delphi study was conducted with experts who rated suitability of each measure. Third, an expert consensus conference (including clinicians, researchers, and people with lived experience) was held to review the measurement properties of each candidate measure and to vote on a final COS of measures for XR. Results:A total of 52 experts participated in the Delphi survey and 15 attended the consensus conference. Among participants, 8 (52%) specialised in pediatric populations, 5 (33%) in adult populations, and 2 (15%) across the lifespan. Within each outcome domain, 2 to 4 measures with the highest rated suitability were selected as candidates. Consensus was achieved on a final COS consisting of 10 measures for pediatric trials and 8 for adult trials. Conclusion:This is a promising and necessary step to advance the field of XR pain research and better understand the effectiveness of XR for pain.

ABSTRACT:Juvenile fibromyalgia (JFM) is a complex and disabling chronic pain condition for which treatment options are limited. The objective of this randomized controlled trial was to compare the relative efficacy of 3 group-based interventions: cognitive-behavioral therapy (CBT) alone, graded aerobic exercise (GAE) alone, or CBT combined with specialized neuromuscular exercise (Fibromyalgia Integrative Training [FIT] Teens), in reducing pain-related disability for adolescents with JFM. Patients with JFM (ages 12-17) who experienced moderate-to-severe pain and pain-related disability were eligible. A total of 317 adolescents (86.4% girls, 84.2% White, mean age 15.8 years) were randomized to receive 8 weeks (16 sessions) of CBT (N = 110), GAE (N = 104), or FIT Teens (N = 103), followed by 4 booster sessions. Our primary hypothesis that the FIT Teens intervention would be superior to CBT or GAE was not supported. Rather, participants in all treatments showed significant reduction in disability with no differences between groups at the 3-month primary endpoint (main effect estimate = -3·94 [95% CI: -6·62 to -1·26]) and at 6-, 9-, and 12-month follow-up (main effect estimate = -4·52 [95% CI: -7·35 to -1·68]; -4·21 [95% CI: -7·13 to -1·29]; and -4·76 [95% CI: -7·84 to -1·68], respectively). Pain intensity was significantly improved at 9- and 12-month follow-up. Although the overall magnitude of improvement in disability was small, approximately 1 in 4 patients in the FIT and CBT groups had clinically remarkable improvement. Cognitive-behavioral and exercise-based treatments are promising for the management of JFM. Further research is needed to examine the characteristics of treatment responders and the mechanisms of improvement.

FACE-Q Craniofacial Module is a validated patient-reported outcome measure for appearance. This study aimed to assess the content validity of FACE-Q Craniofacial Module for use in patients treated for corneal anaesthesia. This was a qualitative, prospective observational study. Cognitive debriefing interviews were conducted with patients ≥8 years old who had surgical treatment for corneal anaesthesia at least six months before time of study. Two rounds of interviews gathered feedback on the comprehensibility, comprehensiveness, and relevance of three eye scales and checklists and four health-related quality-of-life scales. Based on the input from participants, ophthalmologists, scientists, and patient advocates, the scales and checklists were modified, then further refined. Feedback on the FACE-Q scales and checklists was obtained from 10 participants. Instructions for the scales were modified to enhance comprehensibility. Eleven items were revised for enhanced comprehensibility and relevance. Twelve items were added to enhance comprehensiveness. Four items were removed due to their irrelevance to appearance or corneal anaesthesia. Modifications to the eye and health-related quality-of-life scales were generally condition-specific and generic, respectively. A comment section was added to the end of each scale and checklist. The FACE-Q demonstrates strong potential for adaptation to measure appearance outcomes in corneal anaesthesia patients. With lived expertise, clinical, and scientific input, the content validity of FACE-Q was improved for use in corneal anaesthesia patients. The modified FACE-Q is now ready for psychometric evaluation and further validation. Meeting Presentations: Poster Presentation at 2023 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting in New Orleans, LA, April 23-27, 2023.

Despite rising levels of interest in global environmental challenges, progress towards the widespread adoption of pro-environmental behaviours remains slow and inconsistent. Previous literature identifies the importance of education for working to address this inconsistency between the environmental values people hold and their behaviours, commonly described as the value-action gap. To examine current knowledge in this area we conducted a semi-systematic review of published literature which explicitly brings together value-action gap thinking and environmental education research. Our findings reveal that major areas of focus across this literature are either on the role of specific pedagogical approaches or broader policy and institutional structure. Based on our analysis of the literature, we suggest five priorities for future research. This includes research which contextualises educational visions within existing curricula, research which examines intergenerational learning, research which considers possibilities for collective action, research which studies a greater diversity of global locations, and research which examines the whole school approach.

Pediatric AnesthesiaEarly View SHORT REPORT The need for a true biofeedback-based virtual reality system for achievement of target heart rate variability for children undergoing surgery Zandantsetseg Orgil, Zandantsetseg Orgil orcid.org/0000-0003-0641-4135 Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USASearch for more papers by this authorLisa M. Heisterberg, Lisa M. Heisterberg School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorDillon Froass, Dillon Froass School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorAnitra Karthic, Anitra Karthic orcid.org/0000-0002-5182-3512 School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorSara E. Williams, Sara E. Williams Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USASearch for more papers by this authorLili Ding, Lili Ding Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorSusmita Kashikar-Zuck, Susmita Kashikar-Zuck Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorChristopher D. King, Christopher D. King Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorVanessa A. Olbrecht, Corresponding Author Vanessa A. Olbrecht [email protected] Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, Delaware, USA Correspondence Vanessa A. Olbrecht, Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE, USA. Email: [email protected]Search for more papers by this author Zandantsetseg Orgil, Zandantsetseg Orgil orcid.org/0000-0003-0641-4135 Department of Clinical Research Services, Nationwide Children's Hospital, Columbus, Ohio, USASearch for more papers by this authorLisa M. Heisterberg, Lisa M. Heisterberg School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorDillon Froass, Dillon Froass School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorAnitra Karthic, Anitra Karthic orcid.org/0000-0002-5182-3512 School of Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USASearch for more papers by this authorSara E. Williams, Sara E. Williams Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USASearch for more papers by this authorLili Ding, Lili Ding Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorSusmita Kashikar-Zuck, Susmita Kashikar-Zuck Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorChristopher D. King, Christopher D. King Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USASearch for more papers by this authorVanessa A. Olbrecht, Corresponding Author Vanessa A. Olbrecht [email protected] Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Wilmington, Delaware, USA Correspondence Vanessa A. Olbrecht, Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Delaware Valley, 1600 Rockland Road, Wilmington, DE, USA. Email: [email protected]Search for more papers by this author First published: 03 April 2024 https://doi.org/10.1111/pan.14887 Section Editor: Nada Sabourdin Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT None declared. Open Research DATA AVAILABILITY STATEMENT Individual participant data will not be shared with the public, but aggregate data will be publicly available upon request. REFERENCES 1Olbrecht VA, O'Conor KT, Williams SE, et al. Guided relaxation-based virtual reality for acute postoperative pain and anxiety in a pediatric population: pilot observational study. J Med Internet Res. 2021; 23(7):e26328. doi:10.2196/26328 10.2196/26328 PubMedGoogle Scholar 2Yetwin AK, Mahrer NE, Bell TS, Gold JI. Heart rate variability biofeedback therapy for children and adolescents with chronic pain: a pilot study. J Pediatr Nurs. 2022; 66: 151-159. doi:10.1016/j.pedn.2022.06.008 10.1016/j.pedn.2022.06.008 PubMedGoogle Scholar 3Fisher E, Law E, Palermo TM, Eccleston C. Psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2019; 4(4): CD011118. doi:10.1002/14651858.CD011118.pub2 10.1002/14651858.CD011118.pub2 PubMedGoogle Scholar 4Orgil Z, Karthic A, Bell N, et al. Dataset used to refine a treatment protocol of a biofeedback-based virtual reality intervention for pain and anxiety in children and adolescents undergoing surgery. Data Brief. 2023; 49: 109331. doi:10.1016/j.dib.2023.109331 10.1016/j.dib.2023.109331 CASPubMedGoogle Scholar 5Aritzeta A, Aranberri-Ruiz A, Soroa G, Mindeguia R, Olarza A. Emotional self-regulation in primary education: a heart rate-variability biofeedback intervention programme. Int J Environ Res Public Health. 2022; 19(9):5475. doi:10.3390/ijerph19095475 10.3390/ijerph19095475 PubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients' experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes.

ABSTRACT:Juvenile fibromyalgia (JFM) is a chronic condition characterized by symptoms of pain and fatigue and is associated with sedentary behavior and functional disability. Adults with fibromyalgia exhibit deficits in physical fitness as evidenced by lower aerobic capacity and physical endurance, but it is unknown whether these impairments are apparent in adolescents with JFM. Furthermore, the extent to which functional disability and pain interference relate to measures of physical fitness has not been investigated in a pediatric pain population. During a baseline assessment for a clinical trial, 321 adolescents with juvenile fibromyalgia (M age = 15.14, 85.2% female) completed measures of pain intensity, fatigue, JFM symptom severity, functional disability, and pain interference. They also completed 2 validated fitness tasks: (1) the Harvard step test, which assesses aerobic fitness, and (2) the 6-minute walk test, a simple submaximal test of endurance. We examined associations among self-report measures and fitness assessments using bivariate correlations. We then employed hierarchical regression analyses to determine the unique contributions of physical fitness assessments to self-reported functional disability and pain interference. Results indicated that youth with JFM exhibited deficits in aerobic capacity and physical endurance. However, physical fitness explained negligible variance in functional disability and pain interference beyond that accounted for by pain, fatigue, and JFM symptom severity. Scores on available functional disability measures may reflect perceived difficulties in coping with symptoms during physical tasks rather than actual physical capability. Rigorous and sensitive assessments of physical fitness and endurance are needed to determine whether rehabilitation interventions for pediatric pain improve physical functioning.

OBJECTIVE:Cognitive Behavioral Therapy (CBT) for youth with Disorders of Gut-Brain Interaction (DGBIs) is effective; however, there are calls in the field to strengthen the evidence base and identify specific mechanisms of treatment that yield the most benefit for this patient population. A unique, systematic treatment approach of CBT with initial evidence for success for pediatric patients with DGBIs was evaluated to further demonstrate its clinical utility in this population. METHODS:This was a retrospective study of 42 pediatric patients aged 11-17 years with DGBIs, who were diagnosed and referred for CBT by pediatric gastroenterology providers. Providers also completed a survey rating acceptability and effectiveness of CBT. The systematic CBT approach included 10 sessions delivered by a psychologist at an integrated Pediatric GI Clinic. RESULTS:Review of 42 pediatric charts showed significant decreases in self-reported functional disability, abdominal pain, as well as depression and anxiety symptoms pre- to post-CBT completion. A moderation effect was observed where patients reporting higher levels of depressive symptoms and primary symptom of abdominal pain reported smaller reductions in functional impairment compared to those with lower levels of depression and primary symptom of nausea or vomiting. Pediatric Gastroenterology providers were satisfied with this psychological treatment approach. CONCLUSIONS:This study provides evidence for acceptability and effectiveness of implementation of a systematic CBT approach for pediatric DGBIs in an integrated GI clinic, as well as areas worthy of future research, including identifying the most important mechanisms of treatment and factors that influence treatment response.

Background Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established. Objectives The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF. Methods A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children’s Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients’ experiences with VR-BF. Results Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85%). Few patients reported VR-BF as beneficial for pain (8/20, 40%). Conclusions Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. Trial Registration ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874

BACKGROUND:Hypermobile Ehlers-Danlos syndrome (hEDS) is characterized by joint and skin laxity, and often accompanied by chronic pain, dysautonomia, increased distress and, functional limitations. The journey to accurate diagnosis is often prolonged due to unclear etiology of symptoms. This manuscript is a narrative review of the literature on illness uncertainty (IU) in hEDS, highlighting the unique facets of IU in this population, as compared to the broader chronic pain population (given symptom overlap between these two disease groups), that warrant additional investigation. Additionally, we considered the unique challenges associated with IU in the context of the developmental nuances of pediatric populations. Specifically, we aimed to (1) map the extant literature of the IU experience in chronic pain conditions broadly including the pediatric and adult research to identify key concepts related to IU and incorporate potential developmental considerations in IU; (2) delineate and describe the IU experience specifically in patients with hEDS, with the goal of identifying gaps in the literature based on aspects of presentation in hEDS that do and do not differ from the broader chronic pain population; and (3) elucidate the potential areas of adverse impact of IU in both general chronic pain populations, and those with hEDS specifically, to provide actionable areas for future research and clinical care of individuals with hEDS. Results of this review indicate that IU has been well-studied in chronic pain generally, but inadequately evaluated in hEDS specifically. Specific features of hEDS (complexity of the disorder, involvement of multiple bodily systems, contribution of organic pathology) may uniquely contribute to IU in this population. This review suggests that ambiguities surrounding the diagnosis of hEDS, symptom course, and treatment recommendations, along with misdiagnosis, perceived dismissal of symptoms, or attribution of symptoms to mental health concerns might increase risk for IU and related distress in patients.CONCLUSION:Findings from the present review suggest that distinct features of hEDS yield a set of driving factors for IU that may be somewhat different than those faced by patients with chronic pain or other medical conditions. The development of a validated measure of IU to appropriately assess this construct in patients with hEDS is a research priority. In the clinical setting, providers should be attentive to the potentially aversive diagnostic and treatment experiences reported by patients and attempt to provide clear explanations based on the extant knowledge of hEDS, and implement best-practice recommendations for multidisciplinary treatment.

ObjectiveJuvenile 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.MethodsParticipants 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.ResultsParticipants 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.ConclusionJFM 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.