Children with Fibromyalgia Benefit from CBT
Recent research suggests that cognitive behavioral therapy can improve the lives of children and adolescents suffering from fibromyalgia. The condition affects between two and seven percent of school-aged children, primarily adolescent girls. It causes widespread pain, fatigue, disrupted sleep and mood disturbances.
Patients have “substantial physical, school, social and emotional impairments,” says Dr. Susmita Kashikar-Zuck of Cincinnati Children’s Hospital Medical Center in Ohio. As there is no solid evidence for the effectiveness of current treatments, Dr Kashikar-Zuck and her colleagues carried out a randomized trial of cognitive behavioral therapy (CBT).
They recruited 114 adolescents between the ages of 11 and 18 years who suffered from juvenile fibromyalgia. Usual medical care was given for eight weeks. While some patients then saw a psychologist for eight weekly CBT sessions plus two booster sessions over six months, others simply received education on disease management.
CBT was found to be “significantly superior” to disease education at reducing functional disability, showing a 37 percent improvement vs. 12 percent.
Depression scores dropped in both groups, with the average score for both groups falling into the range of normal/healthy. The researchers say, “This implies that attention and support from health care providers via intensive weekly individual sessions can in and of themselves reduce emotional distress.”
They add, “These nonspecific positive effects were also observed in both groups on more global measures of patient-reported health-related quality of life. However, CBT clearly had the additional benefit of significantly improving daily functioning over and above the positive effects on overall well-being.”
Nevertheless, pain was not reduced significantly (i.e. by 30 percent or more) in either group. The effects on sleep quality also were very small, and the sensitivity of so-called “tender points” was mostly unchanged. But the authors say it is encouraging that a marked improvement in the patients’ ability to carry out previously avoided activities such as going to school, doing chores, going out with friends, and the like was achieved without increasing pain or interfering with sleep.
Almost 90 percent of the participants completed the treatment plans and followups. Much of the high retention could probably be attributed to the strong relationship that participants and parents developed with the therapists, say the researchers, because anecdotal reports were positive and treatment credibility ratings at the end of the study were high.