Efficacy of Cognitive-Behavioral Intervention for Juvenile Primary Fibromyalgia Syndrome

SUSMITA KASHIKAR-ZUCK, NICOLE F. SWAIN, BENJAMIN A. JONES, and T. BRENT GRAHAM

ABSTRACT.

Objective. There are currently no controlled studies of behavioral interventions for juvenile primary fibromyalgia syndrome (JPFM). In this small-sample randomized study, we tested the efficacy of a behavioral intervention, i.e., coping skills training (CST), for the treatment of adolescents with JPFM. Outcomes tested in this study were functional disability, pain intensity, pain-coping efficacy, and depressive symptoms.

Methods. Thirty patients with JPFM were randomly assigned to 8 weeks of either CST or self-monitoring. Adolescents in the CST condition received training in active pain-coping techniques, while those in the self-monitoring condition monitored daily pain intensity and sleep quality with no instructions about behavior change. After posttreatment assessment, subjects were crossed over into the opposite treatment arm for 8 weeks (so that all adolescents eventually received both CST and self-monitoring) and were reassessed at Week 16.

Results. At Week 8, adolescents in both conditions showed significant decrease in depressive symptoms and functional disability. Those who received CST showed significantly greater ability to cope with pain than those in the self-monitoring condition and a trend toward decreased pain intensity. At Week 16, adolescents had significantly lower levels of disability and depressive symptoms compared to baseline, but those who received self-monitoring followed by CST seemed to receive the most benefit.

Conclusion. CST can lead to improved functioning among JPFM patients. Although some of the improvement may be due to increased monitoring and attention, CST provides the specific benefit of improving adolescents' ability to cope with pain. (J Rheumatol 2005;32:1594-602)

Key Indexing Terms:

JUVENILE FIBROMYALGIA
COGNITIVE BEHAVIOR THERAPY
PEDIATRIC PAIN

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From the Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Supported by grants from the Cincinnati Children's Hospital Research Foundation and National Institutes of Health Grant 1P60AR47784-01.

S. Kashikar-Zuck, PhD, Associate Professor of Pediatrics; N. Swain, PsyD, Postdoctoral Fellow; B. Jones, PsyD, Postdoctoral Fellow; T.B. Graham, MD, Assistant Professor of Pediatrics.

Address reprint requests to Dr. S. Kashikar-Zuck, Psychology Division, MLC 3015, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229. E-mail: Susmita.Kashikar-Zuck@cchmc.org

Accepted for publication March 7, 2005.

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