Can Behavioral Treatments be Enhanced by Integrative Neuromuscular Training in the Treatment of Juvenile Fibromyalgia?

Abstract

Juvenile fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain and painful tender points, along with a number of other symptoms including fatigue, sleep disturbance, headaches and increased anxiety. JFM primarily affects adolescent females and causes substantial disruption in physical and psychosocial functioning [1-5]. Symptoms (and related interference with functioning) often persist for many years into early adulthood [6]. There is no cure for JFM and currently available medical treatments are of limited benefit. Recent efforts have focused on the integration of cognitive–behavioral techniques into usual medical care to assist adolescents with JFM to better manage their symptoms using muscle relaxation, distraction, pacing activities and cognitive restructuring. This type of cognitive– behavioral therapy (CBT) proved very effective in adolescents with JFM in a randomized clinical trial that demonstrated superior effects of CBT relative to nonspecific psychological support and education [7]. CBT resulted in marked reductions in functional disability and depressive symptoms, and at postintervention follow-up, the study patients treated with CBT fell in the mild range of disability and were within the nonclinical range for depressive symptoms. However, unlike other studies in pediatric pain conditions characterized by localized pain – such as chronic headache or abdominal pain [8] – CBT did not result in clinically significant reductions in pain symptoms for adolescents with JFM. Treatment of widespread pain symptoms, therefore, continues to be a challenge in adolescent patients with this painful musculoskeletal condition. Physical exercise is routinely prescribed for patients with JFM and is recommended by the American Pain Society guidelines for management of fibromyalgia (FM) pain [9]. The guidelines recommend moderately intense aerobic exercise and muscle strengthening exercises at least two-times a week. These recommendations are supported by a number of studies that demonstrate the benefits of exercise on the reduction of pain and fatigue, along with improved quality of life in adult FM. A recent meta-analytic review of aerobic exercise treatments in 35 randomized clinical trials (>2000 adult FM patients) concluded that significant pain reductions could be achieved with low-to-moderate intensity exercise with a frequency of two-to three-times per week [10].