The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program
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J Pediatr. 2015 Sep;167(3):731-7. doi: 10.1016/j.jpeds.2015.06.036. Epub 2015 Jul 21. The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program. Sherry DD1, Brake L2, Tress JL3, Sherker J3, Fash K2, Ferry K4, Weiss PF3.
1Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: firstname.lastname@example.org.
2Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA.
3Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
4Department of Occupational Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA.
OBJECTIVE: To assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy.
STUDY DESIGN: Children with fibromyalgia seen at a tertiary care hospital were treated with 5-6 hours of intensive PT/OT daily and at least 4 hours of psychosocial services weekly. All medications used for fibromyalgia were discontinued. Children underwent standardized testing, including a visual analog scale for pain; the Bruininks-Oseretsky Test of Motor Performance, Second Edition; the Bruce treadmill protocol; the Functional Disability Inventory; the Pain Stages of Change Questionnaire, adolescent version; and the Pediatric Quality of Life Inventory, Teen Report, at 3 time points: at program entry, at the end of the intensive program, and 1 year after the end of the program.
RESULTS: Sixty-four children (median age, 16 years; 95% Caucasian; 94% female; median duration of symptoms, 21 months) were studied. The mean pain score decreased significantly from program entry to the end of the program (from 66 of 100 to 25 of 100; P = .001). At the 1-year follow-up, 33% reported no pain. All measures of function on the Bruininks-Oseretsky Test of Motor Performance, Second Edition improved significantly and remained at that level or continued to improve over the subsequent year. The mean Bruce treadmill protocol time first increased from 588 seconds to 801 seconds (P < .001) and then dropped to 750 seconds (P = .005), which is at the 90th percentile for age and sex. All Pain Stages of Change Questionnaire, adolescent version subset scores improved significantly initially and were stable or improved at 1 year, as did the Pediatric Quality of Life Inventory, Teen Report total score.
CONCLUSION: Children with fibromyalgia can be successfully treated without medications with a very intensive PT/OT and psychotherapy program. They have significantly improved pain and function by subject report and objective measures of function.
Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
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Observation contributed by: Rosie Rock-Evans