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The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program
David D Sherry1, Lori Brake2, Jenna L Tress1
1Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Intensive physical and occupational therapy (PT/OT) combined with psychotherapy significantly reduced pain and improved function in children with fibromyalgia. Many children experienced long-term pain relief and enhanced physical capabilities without medication.
Area of Science:
- Pediatric Rheumatology
- Pain Management
- Rehabilitation Medicine
Background:
- Fibromyalgia in children presents significant challenges to quality of life and daily functioning.
- Current treatment paradigms often involve pharmacotherapy, with varying degrees of success.
- A comprehensive, non-pharmacological approach warrants investigation for pediatric fibromyalgia.
Purpose of the Study:
- To evaluate the efficacy of an intensive, multidisciplinary treatment program for pediatric fibromyalgia.
- To assess both short-term and 1-year outcomes, including pain reduction and functional improvement.
- To determine if medication can be successfully discontinued during this intensive therapy.
Main Methods:
- A cohort of pediatric fibromyalgia patients received intensive daily physical and occupational therapy (PT/OT) alongside weekly psychotherapy.
- All pre-existing fibromyalgia medications were discontinued upon program entry.
- Standardized assessments of pain, motor performance, exercise capacity, functional disability, and quality of life were administered at baseline, post-treatment, and 1-year follow-up.
Main Results:
- Significant reductions in pain scores were observed from program entry to completion (P = .001), with 33% of participants reporting no pain at 1 year.
- Objective measures of motor function (Bruininks-Oseretsky Test) showed significant and sustained improvement.
- Cardiorespiratory fitness (Bruce treadmill protocol) increased significantly, reaching the 90th percentile for age and sex by 1-year follow-up.
Conclusions:
- Intensive PT/OT and psychotherapy offer a viable, medication-free treatment option for pediatric fibromyalgia.
- This multidisciplinary approach leads to substantial and lasting improvements in pain and functional capacity.
- Pediatric fibromyalgia patients can achieve significant clinical benefits through intensive non-pharmacological rehabilitation.
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.
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