title: The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program.
abstract: OBJECTIVE
  To assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy.
  
  
  METHODS
  Children with fibromyalgia seen at a tertiary care hospital were treated with 5-6 hours of intensive PT/OT daily and at least 4 hours of psychosocial services weekly. All medications used for fibromyalgia were discontinued. Children underwent 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, at 3 time points: at program entry, at the end of the intensive program, and 1 year after the end of the program.
  
  
  RESULTS
  Sixty-four children (median age, 16 years; 95% Caucasian; 94% female; median duration of symptoms, 21 months) were studied. The mean pain score decreased significantly from program entry to the end of the program (from 66 of 100 to 25 of 100; P = .001). At the 1-year follow-up, 33% reported no pain. All measures of function on the Bruininks-Oseretsky Test of Motor Performance, Second Edition improved significantly and remained at that level or continued to improve over the subsequent year. The mean Bruce treadmill protocol time first increased from 588 seconds to 801 seconds (P < .001) and then dropped to 750 seconds (P = .005), which is at the 90th percentile for age and sex. All Pain Stages of Change Questionnaire, adolescent version subset scores improved significantly initially and were stable or improved at 1 year, as did the Pediatric Quality of Life Inventory, Teen Report total score.
  
  
  CONCLUSIONS
  Children with fibromyalgia can be successfully treated without medications with a very intensive PT/OT and psychotherapy program. They have significantly improved pain and function by subject report and objective measures of function.
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: sherry@email.chop.edu.
authors.forename: David D
authors.initials: DD
authors.lastname: Sherry
authors.affiliation: Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Lori
authors.initials: L
authors.lastname: Brake
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Jenna L
authors.initials: JL
authors.lastname: Tress
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sherker
authors.affiliation: Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Fash
authors.affiliation: Department of Occupational Therapy, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Ferry
authors.affiliation: Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Pamela F
authors.initials: PF
authors.lastname: Weiss
mesh_terms: D000293:Adolescent; D001155:Art Therapy; D015928:Cognitive Behavioral Therapy; D003887:Desensitization, Psychologic; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D006930:Hyperalgesia / Q000628:therapy; D008297:Male; D009147:Music Therapy; D009788:Occupational Therapy; D026741:Physical Therapy Modalities; D011788:Quality of Life; D064232:Visual Analog Scale