Abstract
A recent randomized multisite clinical trial found that cognitive-behavioral therapy
(CBT) was significantly more effective than fibromyalgia education (FE) in reducing
functional disability in adolescents with juvenile fibromyalgia (JFM). The primary
objective of this study was to examine the psychological processes of CBT effectiveness
by evaluating changes in pain coping, catastrophizing, and coping efficacy and to
test these changes as mediators of continued improvements in functional disability
and depressive symptoms at 6-month follow-up. One hundred adolescents (11–18 years
old) with JFM completed the clinical trial. Coping, catastrophizing, and coping efficacy
(Pain Coping Questionnaire) and the outcomes of functional disability (Functional
Disability Inventory) and depressive symptoms (Children's Depression Inventory) were
measured at baseline, posttreatment, and 6-month follow-up. Participants in both conditions
showed significant improvement in coping, catastrophizing, and efficacy by the end
of the study, but significantly greater improvements were found immediately following
treatment for those who received CBT. Treatment gains were maintained at follow-up.
Baseline to posttreatment changes in coping, catastrophizing, and efficacy were not
found to mediate improvements in functional disability or depressive symptoms from
posttreatment to follow-up. Future directions for understanding mechanisms of CBT
effectiveness in adolescents with chronic pain are discussed.
Perspective
CBT led to significant improvements in pain coping, catastrophizing, and efficacy
that were sustained over time in adolescents with juvenile fibromyalgia. Clinicians
treating adolescents with JFM should focus on teaching a variety of adaptive coping
strategies to help patients simultaneously regain functioning and improve mood.
Key words
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Article info
Publication history
Published online: March 28, 2013
Accepted:
December 29,
2012
Received in revised form:
December 3,
2012
Received:
February 27,
2012
Footnotes
This study was funded by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Grant #R01AR050028 to the first author.
The authors have no conflicts of interest financial or otherwise, related to this study.
Identification
Copyright
© 2013 American Pain Society. Published by Elsevier Inc. All rights reserved.
