Intensive occupational and physical therapy with psychosocial support might treat fibromyalgia pain for children without using medication, according to a recent study.
Findings were published in the September issue of The Journal of Pediatrics.
Fibromyalgia is one of the most common amplified pain syndromes presenting in children, affecting about 2% to 6%, according to background information in the study. Past research examining long-term outcomes has found persistent pain in more than 90% of children with fibromyalgia, and many children suffered sleep disturbances 2.6 years after the diagnosis.
For the study, researchers with the Children’s Hospital of Philadelphia followed a group of 64 children and adolescents ages 13-18 with fibromyalgia who were seen at the hospital from 2008-2011. The children received five to six hours of one-on-one intensive physical and occupational therapy daily and four hours of psychosocial services weekly. The length of the intervention was tailored to meet individual goals for each child, but the average length of the treatment was 23 days. All pain medications were discontinued for the study.
Researchers evaluated the children at the program’s start, end and one year after the program’s end using 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.
Study participants were treated as either day hospital patients or inpatients. The PT/OT, which focused on quickly reestablishing normal function and maximizing aerobic conditioning, included timed activities, scooter boards, treadmill, elliptical, stairs, long-distance community ambulation, strengthening and endurance, and dance or video game activities. Psychosocial support included one-on-one and group sessions with a psychologist for cognitive and behavioral therapy, support for coping during PT/OT sessions and art and music therapy.
Children’s average pain score decreased significantly during the program, with a score of 66 out of 100 at the start and a score of 25 out of 100 at the end, findings showed. When following up after one year, 33% of the participants reported no pain, researchers found.
Using the Bruininks-Oseretsky test, all measures of function improved significantly and either continued to improve or remained stable during the follow-up period, results showed. The participants’ average Bruce treadmill time improved from 588 seconds to 801 seconds during the treatment, the study found. One year later, the average Bruce time had fallen to 750 seconds, researchers found, but that level was at the 90th percentile for age- and sex-matched norms.
“Our children with long-standing fibromyalgia exhibited significant improvement in nearly all of the functional and pain measures that we applied,” the authors wrote. “Function, as measured by the FDI, went from the moderately disabled category to normal and remained normal for the year after program completion.”
The authors note their findings conflict with those from a past study.
“Both the dose of PT/OT and the quality of the therapy differed from traditional PT/OT, in that we focused on desensitization and prolonged aerobics, strengthening and functional activities individualized to the subjects, and did not inquire about pain or let pain or the fear of pain stop them,” the authors wrote. “We believe that this focus on function rather than pain helps children break the pain cycle and overcome the long-standing functional and pain limitations with which they presented.”
The emotional support provided for children and their families is an important part of the program, the authors wrote.
“Dealing with pain and the often-long process of seeking diagnosis and appropriate treatment is an arduous process, both physically and emotionally, for children and their families,” the authors wrote. “Psychotherapy focuses on using cognitive behavioral therapy-based interventions to support children through intensive PT/OT, as well as helping them apply these strategies to coping with stress in life outside of program demands that may be contributing to their pain. Many children benefit from cotreatment during PT/OT to help learn and use strategies in vivo.”
A limitation of the study is that it was not a randomized or controlled trial, the authors wrote.
Study authors are David D. Sherry, MD, Jenna L. Tress, CCRP, Jennifer Sherker, PsyD, and Pamela F. Weiss, MD, MSCE, of the rheumatology division; Lori Brake, PTA, and Katherine Fash, DPT, PT, CSCS, of the physical therapy department; and Kelly Ferry, MOT, OTR/L, of the occupational therapy department.