INTEGRATION OF COGNITIVE BEHAVIORAL THERAPY PLUS GROUP EXERCISE, AND ITS EFFECTS IN MANAGING AND DECREASING PAIN AMPLIFICATION IN JUVENILE FIBROMYALGIA AS COMPARED TO SINGLE THERAPY APPROACHES
Objectives:
-In the setting of adolescents, present findings on single therapy approaches that are normally utilized in the more well-studied adult fibromyalgia population.
-Compare single therapy (cognitive behavioral therapy or physical therapy) approaches to integrative psychosocial/cognitive behavioral therapy and physical programs.
-Evaluate efficacy in reducing juvenile fibromyalgia (JFM) impact & improving functional status
-Summarize evidenced based and current best practices for JFM management.
Introduction:
The objective of this systematic review was to examine primarily pain outcomes from various treatment modalities for juvenile fibromyalgia (JFM). We examine the responses to multidiscipline levels versus single therapy approaches. In the setting of fibromyalgia, cognitive behavioral therapy (CBT) and medicine are typically utilized. While CBT provides guidance in improving coping skills and pharmacotherapy addresses anxiety and depression, both methods do not directly minimize pain. In addition to JFM often getting misdiagnosed, the medicine used in JFM are not FDA approved in adolescents. We hypothesize that multimodal therapies involving CBT and physical exercise will have better outcomes in improved pain in comparison to single modalities.
Methods:
Electronic searches of Cochrane, Ovid Medline, and PubMed were conducted to identify all relevant empirical studies.
P Adolescents with JFM
I CBT plus group exercises
C Single therapy (CBT or PT)
O Improved functional status and decrease in pain amplification phenomenon
Results:
-Structured multimodal therapy involving CBT and group exercise is more effective than the more commonly used CBT and/or medicine
-CBT while helpful in improving coping and daily functioning, it does little to reduce pain
-Group setting exercises reduced pain
-Contrary to previous thought that aerobic and isometric exercise increase immediate pain sensitivity, having gradual increase in challenge of such exercises proved to reduce pain and increase baseline strength
-Invested interest in adult fibromyalgia is paving the way for JFM work
Discussion
-More needs to be done to improve recognition of JFM by peds primary care providers
-Research is interested in quantifying measures of improvement and establishing official clinical guidelines, which are not available at this time