A recent trial shows cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescents with juvenile fibromyalgia. The psychological intervention was found to be safe and effective, and proved to be superior to disease management education. Full findings from this multi-site clinical trial are published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).
Medical evidence reports that juvenile fibromyalgia syndrome affects 2% to 7% of school age children. Similar to adult cases, the juvenile form of the disorder primarily strikes adolescent girls. Both adult and juvenile fibromyalgia patients experience widespread musculoskeletal pain, fatigue, as well as sleep and mood disturbances. Previous studies show that juvenile fibromyalgia patients are burdened with substantial physical, school, social and emotional impairments. However, studies investing treatment for the juvenile form of the disorder are limited.
For the current trial, led by Dr. Susmita Kashikar-Zuck from the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center in Ohio, investigators recruited 114 adolescents between the ages of 11 and 18 years who were diagnosed with juvenile fibromyalgia. The trial was conducted at four pediatric rheumatology centers between December 2005 through 2009, with participants randomized to cognitive-behavioral therapy or fibromyalgia education, receiving eight weekly individual therapy sessions and two additional sessions in the six months following the end of active therapy.
Analyses showed that both patient groups displayed significant reduction in functional disability, pain, and depressive symptoms at the end of the trial. Pediatric participants in the cognitive-behavioral therapy group reported a significantly greater reduction in functional disability compared to those receiving fibromyalgia education. The therapy group had a 37% improvement in disability compared to 12% in the education cohort. Both groups had scores in the non-depressed range by the end of the study, but pain reduction was not clinically significant – a decrease in pain of less than 30% for either group.
Fibromyalgia in children is more commonly referred to as juvenile fibromyalgia. Today more and more pediatricians and pediatric specialists are beginning to recognize that children under the age of 18 really can have this syndrome, which is very similar to that which is seen in adults but with some very mild differences (i.e. children suffer from less pain in their muscles and tender points). With this in mind it is important to understand what children with fibromyalgia really are dealing with.
Symptoms Of Juvenile Fibromyalgia
Fibromyalgia in children comes with numerous symptoms. Doctors who are diagnosing a child with fibromyalgia will pay special attention to those that parents feel are truly affecting the child’s life. However, some of the most common complaints from a parent of a child who has fibromyalgia include:
Children may display a lack of energy even though they seem to have slept the appropriate amount of time the night before. This is because children may be unable to fall asleep or stay asleep whenever they have juvenile fibromyalgia.
– A lot of children will have chronic headaches that range in intensity from mild to severe.
– Most children who have fibromyalgia do experience pain. This can be triggered by physical activity, weather or stress. If the child experiences any type of anxiety, then this can also affect whether or not the child experiences pain and to what intensity it is experienced.
– Many children will oftentimes appear really restless and anxious. Whenever they have sever fibromyalgia the child will also experience depression to varying degrees.
The drop-out rate was low with over 85% of participants attending all therapy sessions and no study-related adverse events were reported by investigators. “Our trial confirms that cognitive-behavioral therapy is a safe and effective treatment for reducing functional disability and depression in patients with juvenile fibromyalgia,” concludes Dr. Kashikar-Zuck. “When added to standard medical care, cognitive-behavioral therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”
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There are many theories, among them hypersensitivity among the nociceptor fibers in the spinal cord, leading to the pathological difference in the experience of pain. Genetics have been hypothesized to play a role, as have environmental factors-including anxiety and depression.
And anxiety and depression may worsen due to the impact juvenile fibromyalgia has on the daily lives of these patients, as studies have found that juvenile fibromyalgia patients are more socially isolated and have inferior family relationships compared to normal patients. Interestingly, mothers of juvenile fibromyalgia patients are five times more likely to suffer fibromyalgia; this compounds already problematic intra-family coping.
Treatments include education, including an emphasis on the importance of sleep, and the necessity of appropriate physical activity. If necessary, prescriptions for sleep and psychological afflictions, headaches and irritable bowel symptoms can be given with sometimes great effect. Nevertheless, the chief complaint that brings so many to the doctor’s office, pain, is often refractory to medications – and many other interventions.
This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of the article may contact healthnews@wiley.com.
Full citation:
A Randomized Clinical Trial of Cognitive Behavioral Therapy for the Treatment of Juvenile Fibromyalgia.” Susmita Kashikar-Zuck, Tracy V. Ting, Lesley M Arnold, Judy Bean, Scott W. Powers, T. Brent Graham, Murray H. Passo, Kenneth N. Schikler, Philip J. Hashkes, Steven Spalding, Anne M. Lynch-Jordan, Gerard Banez, Margaret M. Richards and Daniel J. Lovell. Arthritis & Rheumatism; Published Online: November 22, 2011 (DOI: 10.1002/art.30644).
Author Contact: To arrange an interview with Dr. Kashikar-Zuck, please contact Jim Feuer with the Cincinnati Children’s Hospital Medical Center at jim.feuer@cchmc.org .
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Dawn Peters
healthnews@wiley.com
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Wiley-Blackwell