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Behavioral therapy may ease kids' fibromyalgia

By Linda Thrasybule

NEW YORK (Reuters Health) - Teaching teens coping skills to deal with the chronic pain of fibromyalgia may provide them some relief, a small study suggests.

When researchers divided 114 teenagers with the condition into two groups -- one that received behavioral therapy for six months and one that just got information about the condition -- the behavioral therapy group emerged with much lower levels of disability at the end of the study.

"This is the first major breakthrough in understanding how best to treat fibromyalgia in teenagers," said study co-author Dr. Susmita Kashikar-Zuck, a pediatric psychologist at the Cincinnati Children's Hospital Medical Center.

"Because of their pain, these teens have trouble going to school, going out with friends, participating in social activities -- things important to teenagers," she said.

People with fibromyalgia suffer from intense pain all over their bodies. They may feel tired all the time, have trouble sleeping, become anxious or depressed and suffer from other conditions such as irritable bowel and arthritis.

About five million adult Americans have the condition, according to the Centers for Disease Control and Prevention.

The exact number of kids with fibromyalgia is unknown. Based on past research into rates seen among U.S. school children, Kashikar-Zuck estimates roughly 850,000 kids between the ages of 10 to 19 may have symptoms of chronic widespread pain -- although few seek specialized treatment.

The cause of fibromyalgia is also undetermined, but some researchers believe it may be linked to how the brain processes pain.

"We've come to understand this disorder better, said Dr. Jeffrey Dvergsten, a pediatric rheumatologist at Duke University School of Medicine who was not part of the study.

"It was once thought that people with chronic pain were imagining it all in their head," he told Reuters Health. "But for the past 20 years, we've learned there's a lot more to pain than we previously understood."

At the beginning of the study, all the participants had some limitations when performing daily activities, such as trouble waking up because of fatigue, trouble participating in social activities or physical sports, and difficulty performing chores.

On a scale of "functional disability" where 30 is the most disabled, both groups scored around 20.

Teens who received behavioral therapy learned how to use various techniques to distract themselves from the pain, how to pace their activities so they weren't overwhelmed and how to calm themselves when they felt anxious.

The information-only group got lessons that discussed the disorder, available treatments and lifestyle issues, and they received handouts to take home.

After six months, both groups improved their daily functioning. Teens who learned coping skills through behavioral therapy reached an average disability score of 13 out of 30, while those who got the lessons scored 17 out of 30, according to findings reported in Arthritis and Rheumatism.

"These teens were getting individualized treatment, learning active skills where we're teaching them to include behavioral changes in their life," said Kashikar-Zuck.

Both groups showed slight improvements in mood, despite only minimal changes in their reported severity of pain.

Fibromyalgia treatments can include painkillers, antidepressants, cognitive-behavioral therapy and exercise. No medications are available for children and teenagers, however.

Dvergsten thinks it takes more than just behavioral therapy to manage chronic pain. He suggests that a three-pronged approach -- including behavioral therapy, physical therapy and treating sleep problems -- should be used. But he does see the study as a sign of hope for kids.

"A child dealing with pain doesn't have to grow up to be an adult dealing with pain," he said. "There is help for this."

SOURCE: http://bit.ly/sIvhcJ Arthritis and Rheumatism, November 22, 2011.

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