Cognitive behavioral treatment of juvenile primary fibromyalgia syndrome

Abstract

This study evaluated the efficacy of a manualized CBT that managed physical and psychological symptoms of JPFS. Eighty children (72% female, 14% male) diagnosed with JPFS were treated in our large-scale Fibromyalgia Treatment Program. Children's ages ranged from 8 to 22 years old ( M = 14.1 years). All children had multiple tenderpoints ( M = 7.3), and most reported symptoms of anxiety and/or depression. Many children had concurrent medical conditions including migraine headaches (64%), chronic fatigue syndrome (56%) and irritable bowel syndrome (51%).;Children participated in a comprehensive eight-week CBT protocol consisting of psychoeducation, pain management, sleep hygiene, stress management, and aerobic exercise. Specific techniques included: daily diaries to record pain, sleep and exercise; cognitive restructuring; behavioral contracting; and relaxation/hypnosis. Children and their parents completed measures of the child's status pre- and post-treatment. Measures of physical condition included the Functional Disability Inventory (FDI), Fatigue Severity Scale (FSS), Children's Somatization Inventory (CSI) and visual analogue scales of current pain and worst pain in the past month. Psychological measures included the Multidimensional Anxiety Scale for Children (MASC), and the Child Behavioral Checklist (CBCL).;Completers of treatment did not differ significantly from non-Completers on any demographic or disease characteristics. Orthogonal and oblique principal components analyses (PCA) of JPFS symptoms yielded two components: physical and psychological symptoms. Somatization loaded approximately equally on the two components. A MANOVA of pre-treatment and post-treatment difference scores yielded a significant multivariate effect. Univariate post-hoc tests indicated that, in children who completed the CBT treatment, there were significant improvements in pain, fatigue, functional disability, somatization, anxiety, and parental report of internalizing behaviors. Based upon PCA results, physical and psychological composite T-scores were calculated for pre- and post-treatment measures. A subsequent MANOVA utilizing composite T-scores yielded higher effect sizes and greater explanatory power than that of any individual measure.;Significant decreases in pain, fatigue, functional disability and improvements in overall psychological functioning are encouraging. Results of this large-scale study suggest that CBT is a viable treatment approach to JPFS. A model incorporating the distinct physical and psychological components of JPFS provide direction for future research and treatment.