Preliminary Outcomes of a Cross‐Site Cognitive–Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia
Open accessAbstract
Objective: Cognitive–behavioral therapy (CBT) is effective in reducing disability among youth with juvenile fibromyalgia (FM); however, engagement in moderate to vigorous physical activity remains poor, even after CBT. The purpose of this study was to evaluate the feasibility and preliminary outcomes of an innovative program combining CBT with specialized neuromuscular exercise: the Fibromyalgia Integrative Training for Teens (FIT Teens) program. Methods: Adolescents with juvenile FM (n = 22, all female, ages 12–18 years) from 2 urban children's hospitals participated in the 8‐week FIT Teens intervention. Participants completed measures of pain intensity, functional disability, depressive symptoms, pain catastrophizing, fear of movement, and readiness to change at baseline and after the intervention. Results: The feasibility of the intervention across 2 sites was documented, including high retention rates (80%). Participants showed significant decreases in functional disability (P < 0.05), depression (P < 0.001), fear of movement (P < 0.01), and pain catastrophizing (P < 0.001) from pre‐ to postintervention. Results of the readiness to change measure indicated a significant decrease in precontemplation (P < 0.01) and increase in action/maintenance scores (P < 0.001). All results demonstrated medium to large effect sizes. Conclusion: Adolescents with juvenile FM reported significant improvements in physical function and reduced fear of movement following the intervention. Improvement in physical function was achieved in a shorter time frame than in a prior trial of CBT without an exercise component. Further work is needed to compare the FIT Teens program with existing approaches and determine whether objective changes in exercise participation are achieved.
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Fibromyalgia is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.
“Fibromyalgia (FM) is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.1–11”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The paper’s introductory passage (indexed under Abstract > Conclusion; page unavailable) describes juvenile fibromyalgia as a chronic pain condition involving widespread pain, fatigue, sleep difficulties, and anxiety or depressive symptoms. The Study Measures section also addresses functional disability. Our copy does not characterize the pain as medically unexplained or identify cognitive disorders as a symptom, and its description is specifically of juvenile fibromyalgia rather than fibromyalgia generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredCBT combined with adapted physical activity appears more effective than either intervention alone.
“CBT combined with adapted physical activity appears more effective than either intervention alone.9,17”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The Discussion reports faster improvement in physical function than in a prior CBT-only trial and improvement in fewer sessions than in a prior aerobic-exercise trial. But this pilot had no control group, the aerobic intervention had a greater effect on pain, and the authors say future trials are needed to determine whether the combined program is superior to either intervention alone. Page numbers were not provided. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCognitive behavioural therapy (CBT) for FM is effective in reducing symptoms of depression, functional disability, and catastrophizing and increasing pain-coping efficacy, but does not result in greater engagement in more vigorous activity or exercise when applied in isolation.
“Cognitive behavioural therapy (CBT) for FM is effective in reducing symptoms of depression, functional disability, and catastrophizing and increasing pain-coping efficacy,9,17 but does not result in greater engagement in more vigorous activity or exercise when applied in isolation.17”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredBalance confidence, decreased muscle strength and altered biomechanics can negatively affect patients' quality of life by increasing the risk of falling, fall-related injuries and fear of falling.
“Balance confidence, decreased muscle strength and altered biomechanics can negatively affect patients’ quality of life by increasing the risk of falling, fall-related injuries and fear of falling,9,17,19,30”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The Abstract > Conclusion says adolescents with juvenile fibromyalgia show strength deficits and altered biomechanics that may contribute to fear of movement and movement-related pain. It does not link those deficits or balance confidence to falls, fall-related injuries, fear of falling, or reduced quality of life; fear of movement is not the same as fear of falling. (LLM, conf=0.86)
Experimental — accuracy not yet measuredKinesiophobia and pain catastrophizing are prevalent in fibromyalgia.
“Kinesiophobia and pain catastrophizing are prevalent in FM and are strongly associated with decreased physical performance, reduced postural control, and muscle weakness,9,17,29”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The Study Measures section assesses fear of movement and pain catastrophizing in adolescents with juvenile fibromyalgia, and the Discussion reports that both decreased during the intervention. These passages show that the concerns were present in this small study, but they do not establish how prevalent they are in fibromyalgia generally. The cited passages also do not establish the stated strong associations with physical performance, postural control, or muscle weakness. Page numbers are unavailable in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Kinesiophobia and pain catastrophizing are strongly associated with decreased physical performance, reduced postural control, and muscle weakness in fibromyalgia.
“Kinesiophobia and pain catastrophizing are prevalent in FM and are strongly associated with decreased physical performance, reduced postural control, and muscle weakness,9,17,29”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The Introduction reports strength deficits and altered biomechanics in adolescents with juvenile fibromyalgia and suggests these may contribute to fear of movement. The Study Measures and Discussion address fear of movement and pain catastrophizing, but do not establish strong associations with physical performance, postural control, or muscle weakness. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredProviding patients with EMDR, CBT, biofeedback or rTMS may enable them to gain control over physical processes, allowing for improved functional task performance and increased autonomy in their rehabilitation.
“Providing patients with EMDR,4 CBT,9,12,17 biofeedback24 or rTMS26,33 may enable them to gain control over physical processes, allowing for improved functional task performance and increased autonomy in their rehabilitation.24”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
The Intervention and Discussion sections describe CBT coping skills practiced during neuromuscular exercises, improved self-reported functioning, and greater readiness to manage pain among adolescents with juvenile fibromyalgia (page numbers unavailable). These findings support the CBT-related possibility of better daily functioning and self-management, but the study tested a combined intervention and did not establish that CBT alone gives patients control over physical processes or increases rehabilitation autonomy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe positive outcome for MPM contributes to a critical and growing evidence base supporting CBT and PT for pain treatment in youth.
“The positive outcome for MPM in this trial contributes to a critical and growing evidence base supporting CBT and PT for pain treatment in youth[27; 31; 63; 64].”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [63]
Regular moderate to vigorous physical activity and weight-bearing exercises are recommended for pain management in patients with FM, but adherence to these recommendations is often poor.
“Regular moderate to vigorous physical activity and weight-bearing exercises are recommended for pain management in patients with FM,5,21 but adherence to these recommendations is often poor.9,17,30”
From A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment (2025) · cites this paper as [9]
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Cites
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Sorted by citations
Kashikar-Zuck, S., Black, W. R., Pfeiffer, M., Peugh, J., Williams, S. E., Ting, T. V., Thomas, S., Kitchen, K., & Myer, G. D. (2018) · The Journal of Pain · doi:10.1016/j.jpain.2018.04.003 · Cited by 59 · see citing works
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A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment
Quodling, N., Hoffman, N., Carrick, F., & Jemni, M. (2025) · Journal of Pain Research · doi:10.2147/jpr.s543775 · Cited by 5 · see citing works
- Authors
- Tran, S. T., Guite, J. W., Pantaleao, A., Pfeiffer, M., Myer, G. D., Sil, S., Thomas, S. M., Ting, T. V., Williams, S. E., Edelheit, B., Ounpuu, S., Rodriguez‐MacClintic, J., Zemel, L., Zempsky, W., & Kashikar‐Zuck, S.
- Affiliations
- DePaul University (US)
- University of Connecticut (US)
- Connecticut Children's Medical Center (US)
- Cincinnati Children's Hospital Medical Center (US)
- Emory University (US)
- Connecticut Children's Medical Center and University of Connecticut School of Medicine Hartford
- ORCID
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2017-02-25
- Volume
- 69
- Issue
- 3
- Pages
- 413-420
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC5179324
- OpenAlex
- W2462379983
- Cited by
- 44
- References
- 7
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 1 · 2022: 6 · 2021: 9 · 2020: 3 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 2
- FWCI
- 4.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children's Hospital Medical Center and by the Connecticut Children's Medical Center.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, a division of the NIH (K24-AR-056687 and R21-AR-063412)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- juvenile fibromyalgia, cognitive behavioral therapy, neuromuscular training, adolescents, physical activity participation, functional disability, depression, pain catastrophizing, kinesiophobia, readiness to change, precontemplation, intervention feasibility
- MeSH terms
- Adolescent, Adolescent Behavior, Child, Child Behavior, Combined Modality Therapy, Depression, Disability Evaluation, Exercise Therapy, Fear, Feasibility Studies, Female, Fibromyalgia, Hospitals, Pediatric, Hospitals, Urban, Humans, Pain Measurement, Surveys and Questionnaires, Time Factors, United States, Cognitive Behavioral Therapy, Treatment Outcome, Age of Onset, Recovery of Function, Catastrophization
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