Fibromyalgia in Children: No Medication Required

David D. Sherry, MD


September 08, 2015

Editorial Collaboration

Medscape &

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This is Dr David Sherry, director of the Amplified Pain Program at The Children's Hospital of Philadelphia (CHOP). Today I'd like to bring to your attention the exciting results of our study on childhood fibromyalgia.[1]

Childhood fibromyalgia is a very intensely painful, chronic condition that affects anywhere from 2% to 6% of the population. It is thought to be long-lasting. A study[2] of adolescents with juvenile-onset fibromyalgia followed these patients into early adulthood and concluded that > 80% of these patients still had chronic pain as adults.

We've taken a different approach to treating these children here in Philadelphia. We give them a very intense physical and occupational therapy treatment program: 5-6 hours a day of very aggressive, intense, aerobically based exercises and desensitization for children with tenderness to light touch. We also take the children off of pain medications, sleep medications, and any other medication that's been used to treat fibromyalgia symptoms.

With this program, we studied 64 children who had reported pain for about 2 years before we saw them. Pain intensity averaged 7.1 out of 10. We treated these children with this very intense exercise program for an average duration of 23 days. At the end of that time, reported pain intensity had decreased to approximately 2.5 out of 10. One year later, when the children retuned to be evaluated again, their pain had decreased further to an average of 2.0 out of 10. One third of the children reported absolutely no pain whatsoever, and one half reported pain intensity of less than 1 out of 10.

We also looked at the reported endurance of the children in the sample by conducting a Bruce treadmill protocol, where the children get on a treadmill and the treadmill speed and angle are increased every 3 minutes until the children had to say "quit." Initially, the mean treadmill time the children were able to sustain was less than 10 minutes, which was approximately the 25th percentile for age and gender.

At the end of the treatment program, treadmill time had increased to a mean of 13.5 minutes, and this endurance was very durable. That surprised us. One year later, the mean time sustained on the Bruce treadmill protocol was 12.5 minutes, which is above the 90th percentile for their age and sex.

We also looked at their physical, emotional, and school functioning, and all improved dramatically over time. We looked at fine motor and gross motor control with the Bruininks-Oseretsky test of motor performance. That assessment, too, not only increased at the end of the treatment program, but 1 year later when the teens returned and were retested, had significantly increased again.

Fibromyalgia is a very treatable condition in childhood. The symptoms do not require medications but can be treated directly with physical and occupational therapy and counseling. Most of these children can be well. They can get back into their sports; they can get back into school; and they can have a functioning, productive life. There are several programs across the country treating children with this kind of intervention, and we hope to have more.

Thank you very much for your time.