Rigorous Trial Supports Cognitive Therapy for Juvenile Fibromyalgia

Fibromyalgia is fairly rare among children, but when it occurs it can be devastating. The 2-7% of children who have near-constant musculoskeletal pain contend with social and emotional issues, as well as interference with their education, and the condition tends to persist to adulthood. However, research into the juvenile form of the disorder has been limited and conflicting.

Now a mutlicenter study offers hope for relief, if not resolution, of the condition.

The randomized trial, comparing targeted cognitive behavior therapy (CBT) with general education about fibromyalgia, involved 114 patients between the ages of 11 and 18 diagnosed at four pediatric rheumatology centers in the United States. Both groups showed improvement in functional disability and depression, but results for CBT were "demonstrably" better.

The education-only intervention reduced disability scores by 12%, while the therapy group had a 37% improvement. Many of the patients in that group approached "minimally disabled" status by the end of the trial. Although CBT did not have a substantially greater effect on pain or sleep difficulties, the subjects in that group were more likely return to normal levels of educational or social activity.

The study, headed by a team from Cincinnati Children's Hospital, is published in Arthritis & Rheumatism. The form of CBT used in the trial is "amenable to dissemination," say the authors. Although it requires the involvement of a trained psychologist, most child psychologists are familiar with CBT techniques, they say.

"Research on CBT in  youth with chronic pain has been limited by small sample sizes, limited trial work with children with musculoskeletal pain, and limited data on functional disability," says pediatric psychologist Tonya Palermo of Seattle Childrens Hospital, who has collaborated with the Cincinnati team in functional assessments of chronic pain in children. She feels that their "strong multi-center trial ... in a large sample of youth" resolves all of these issues, with "extremely promising" results.

Palermo was lead author on a small 2009 study that showed Internet-based family CBT effective for chronic pain in children. One-fourth of the children in that study had musculoskeletal pain.

She is now recruiting for a much larger trial of the Web-based CBT intervention involving 600 adolescents and teens with chronic pain, including fibromyalgia. The new trial should be complete in 2015.

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