Fibromyalgia Integrative Training for Adolescents With Juvenile Fibromyalgia

Juvenile-onset fibromyalgia (JFM) is a chronic, debilitating pain condition that typically
persists into adulthood for the majority of patients. Whereas medications offer limited and
short-term symptom relief for JFM, our research group has demonstrated that
cognitive-behavioral therapy (CBT) is safe, effective and durable in reducing functional
disability and depressive symptoms in adolescents with this condition. However, 60% of
patients receiving CBT did not show clinically significant improvement in functional
disability, and pain levels remained in the moderate range despite being reduced overall. Our
multidisciplinary team of experts in Behavioral Medicine, Rheumatology and Exercise Science
has developed and tested the feasibility of a new Fibromyalgia Integrative Training program
for Teens (FIT Teens), which enhances the established CBT intervention with a novel
neuromuscular exercise training program derived from evidence-based pediatric injury
prevention research. Pilot testing showed excellent patient engagement, no adverse effects
and very promising early results indicating this treatment to have even stronger effects on
disability and pain outcomes than CBT alone. This trial evaluates whether the FIT Teens
intervention is more effective than CBT alone or graded aerobic exercise alone and whether
treatment effects are sustainable over 1 year follow-up.

Inclusion Criteria:

- Juvenile Fibromyalgia diagnosis by pediatric rheumatologist or pain physician and
confirmed by 2010 American College of Rheumatology (ACR) criteria modified for
pediatric use

- Functional Disability Score ≥ 13, indicating at least moderate disability

- Average pain intensity in the past week ≥ 4 on a 0 -10 cm Visual Analog Scale

- Stable medications prior to enrollment

Exclusion Criteria:

- Comorbid rheumatic disease (e.g. juvenile arthritis, systemic lupus erythematous)

- Untreated major psychiatric diagnoses (e.g. bipolar disorder, psychoses, symptoms of
major depression) or documented developmental delay

- Any medical condition determined by their physician to be a contraindication for
physical exercise

- Taking opioid pain medication