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Reducing Disability and Depression in Adolescents with Fibromyalgia by Psychological Intervention

  • Synopsis: Published: 2011-11-22 (Revised/Updated 2012-09-21) - Recent trial shows cognitive-behavioral therapy reduces functional disability and depressive symptoms in adolescents with juvenile fibromyalgia. For further information pertaining to this article contact: Wiley-Blackwell.
Juvenile Primary Fibromyalgia Syndrome (JPFS) - A musculoskeletal pain syndrome characterized by multiple discrete tender points (TPs), fatigue, and sleep disturbance in the child and adolescent. The pain experienced is modulated by factors such as activity, anxiety, stress, and weather changes.

Main Document

Psychological intervention reduces disability and depression in adolescents with fibromyalgia - Cognitive-behavioral therapy is safe and effective treatment for juvenile fibromyalgia.

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.

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."

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).

About the Journal

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology (www.rheumatology.org) is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. For details, please visit onlinelibrary.wiley.com/journal/10.1002/(ISSN)1529-0131.

About Wiley-Blackwell - Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (www.wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

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