Juvenile Fibromyalgia: Intensive Therapy Relieves Pain

Larry Beresford

August 25, 2015

Children with fibromyalgia experienced significant improvements in pain and function without medications after an intensive program of physical therapy (PT), occupational therapy (OT), and psychosocial services, according to a new study. The improvements were still significant 1 year after completing the program.

David D. Sherry, MD, from the Division of Rheumatology at Children's Hospital of Philadelphia, and colleagues present their findings in an article published online July 21 in the Journal of Pediatrics.

"Our children with long-standing fibromyalgia exhibited significant improvement in nearly all of the functional and pain measures that we applied," the authors write.

The study enrolled 64 of 81 patients with juvenile fibromyalgia (median age, 16 years) who were already participating in an intensive musculoskeletal pain program. Most of the patients were white girls. The patients discontinued all their medications at enrollment.

Physical and occupational therapy involved 5 to 6 hours per day of therapeutic activities such as long-distance community ambulation and running up and down stairs, with the goal of reestablishing normal function and maximizing aerobic conditioning. In addition, patients participated 4 hours a week in cognitive and behavioral therapy one on one or in groups, along with art, music, and family therapies.

"Both the dose of PT/OT and the quality of the therapy differed from traditional PT/OT, in that we focused on desensitization and prolonged aerobics, strengthening, and functional activities individualized to the subjects, and did not inquire about pain or let pain or the fear of pain stop them," the authors write.

"We believe that this focus on function rather than pain helps children break the pain cycle and overcome the long-standing functional and pain limitations with which they presented."

The researchers used a pain visual analogue scale; the Pediatric Quality of Life Inventory, Team Report; a functional disability inventory; and other measures of ability to achieve and maintain normal functioning. The latter included the Bruce Treadmill Protocol, which consists of walking on a gradually accelerating treadmill for 21 minutes or until the patient is unable to continue.

The researchers tallied results at baseline, on completion of the intensive program, and 1 year later.

At the end of the program, the mean pain score decreased significantly from program entry (from 66 of 100 to 25 of 100; P = .001). One third of patients reported no pain at 1 year after program completion.

The mean Bruce Treadmill Protocol time fell slightly over the year after program completion, but scores remained significantly better than those at program entry (P < .001) and remained at or above the 90th percentile for age and sex compared with below the 25th percentile at enrollment.

Scores improved significantly initially and remained stable or improved at 1 year for all Pain Stages of Change Questionnaire, adolescent version subset; the Pediatric Quality of Life Inventory, Teen Report; and the Bruininks-Oseretsky Test of Motor Performance, Second Edition.

Fibromyalgia is an incurable musculoskeletal disorder and pain syndrome of unknown etiology and elusive treatment solutions. Defined by persistent, amplified, widespread pain associated with five or more of 18 trigger points, it affects between 2% and 6% of the pediatric population. More than 90% of patients report persistent pain and sleep disturbance, with persistent symptoms into adulthood.

"[T]hese children had long-standing pain that did not remit with less-intensive therapy," the authors note.

Bottom line, they say: "Children with fibromyalgia can be successfully treated without the use of medications and can regain normal function, achieve remission or marked reduction of pain, and experience increased quality of life with an interdisciplinary approach that uses much more intensive [physical and occupational therapy] than is common in most pain programs, along with cognitive, behavioral, and other psychosocial supports."

Funded by the Children’s Hospital of Philadelphia and the Snider Family. The authors have disclosed no relevant financial relationships.

J Pediatrics. Published online July 21, 2015. Abstract

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