Fibromyalgia Integrative Training Program for Teens (FIT Teens)

描述（由申请人提供）：青少年纤维肌痛（JFM）是一种慢性和使人衰弱的疼痛状况，其特征是广泛的疼痛、压痛点、疲劳，通常伴有情绪障碍。JFM无法治愈，药物只能提供有限的短期症状缓解。在最近的一项多中心随机试验中，我们证明了认知行为疗法（CBT）显著改善了JFM青少年的功能障碍和抑郁症状。[尽管功能有所改善，但患有JFM的青少年在CBT后继续遭受中度疼痛症状。有很有希望的证据表明，CBT和体育锻炼相结合可以减少纤维肌痛（FM）疼痛。不幸的是，FM患者很难开始和保持定期参加中等强度的体力活动，这可能是由于久坐不动的生活方式加上缺乏适当的身体力学教育。在这个项目中，我们建议开发和测试一个新的青少年纤维肌痛综合训练计划（FIT Teens），这将通过整合一个从儿科运动医学/损伤预防协议修改的新神经肌肉计划来加强既定的CBT干预。该计划包括综合神经肌肉训练，重点是提高安全地从事更多体力活动所需的基本运动技能。该计划的创新功能包括：1）专门设计的神经肌肉训练，以限制延迟性肌肉酸痛，这可能会模仿JFM的症状; 2）与CBT无缝集成，以增强对增加体力活动的坚持和参与。这个跨学科项目的主要目标是开发一种专门和持久的自我管理干预措施，以影响JFM青少年疼痛，功能障碍和抑郁症状的关键结果。目的1是测试FIT青少年计划的可行性和可接受性。我们将试点为期8周（16 会议），对8名患有JFM的青少年（年龄12-18岁）进行基于小组的干预，以获得有关可行性、安全性、耐受性的信息，以及有关计划格式和内容的定性反馈，这将有助于方案的改进。目的2是进行一项试验性两组试验（N=48），以评估FIT Teens计划在减轻JFM青少年疼痛强度方面是否上级单独使用CBT。将在基线、治疗后和3个月随访时进行评估。我们假设，在3个月的随访中，FIT Teens组的疼痛减轻程度将显著高于CBT组。预计两组在功能障碍和抑郁症状方面都有显着改善。在探索性目标中，我们将测试改善的身体生物力学（3-D运动分析，测力计），依从性，增加的体力活动（加速度计），更低的灾难性和更大的信心在解释疼痛结果的体力活动中的作用。如果FIT Teens在这项探索性试验中显示出比CBT更大的疗效，则这些措施将用于大规模的机制试验。

DESCRIPTION (provided by applicant): Juvenile fibromyalgia (JFM) is a chronic and debilitating pain condition in adolescents characterized by widespread pain, tender points, fatigue, and is often accompanied by mood disturbances. There is no cure for JFM and medications offer limited and short-term symptom relief. In a recent multi-site randomized trial, we demonstrated that cognitive-behavioral therapy (CBT) dramatically improved both functional disability and depressive symptoms in adolescents with JFM. [Despite improvements in functioning, adolescents with JFM continued to suffer from moderate pain symptoms after CBT. There is promising evidence that combined CBT and physical exercise reduce fibromyalgia (FM) pain. Unfortunately, regular participation in moderate-vigorous physical activity is notoriously difficult to initiate and maintain in FM patients, potentially due to sedentary lifestyes combined with lack of education in proper body mechanics. In this project, we propose to develop and test a new Fibromyalgia Integrative Training program for Teens (FIT Teens), which will enhance the established CBT intervention through integration with a novel neuromuscular program modified from pediatric sports medicine/injury prevention protocols. The program consists of integrative neuromuscular training focused on improving fundamental movement skills needed to safely engage in more physical activity. The program's innovative features include1) neuromuscular training specifically designed to limit delayed muscle soreness which could mimic the symptoms of JFM and 2) seamless integration with CBT to enhance adherence and engagement in increased physical activity. The primary goal of this interdisciplinary project is to develop a specialized and durable self-management intervention to impact the key outcomes of pain, functional disability and depressive symptoms in adolescents with JFM. Aim 1 is to test the feasibility and acceptability of the FIT Teens program. We will pilot the 8-week (16 session), group-based intervention with 8 adolescents with JFM (ages 12-18) to obtain information about feasibility, safety, tolerability, and qualitative feedback about the format and content of the program that will aid in protocol refinements. Aim 2 is to conduct a pilot two-arm trial (N=48) to evaluate whether the FIT Teens program is superior to CBT-alone in reducing pain intensity in adolescents with JFM. Assessments will occur at baseline, post-treatment and 3- month follow-up. We hypothesize that the FIT Teens group will have significantly greater pain reduction than the CBT group by the 3-month follow-up. Both groups are expected to show significant improvement in functional disability and depressive symptoms. In exploratory aims, we will test the role of improved body biomechanics (3-D motion analysis, dynamometry), adherence, increased physical activity (accelerometry), lower catastrophizing and greater confidence in physical activity in explaining pain outcomes. These measures will then be used in a large-scale mechanistic trial if FIT Teens shows greater efficacy compared to CBT in this exploratory trial].