Fibromyalgia Integrative Training Program for Teens (FIT Teens)

描述（由申请人提供）：青少年纤维肌痛（JFM）是青少年中一种慢性和衰弱性疼痛状况，其特征是广泛的疼痛，压痛点，疲劳，并经常伴有情绪障碍。JFM无法治愈，药物治疗只能有限地缓解短期症状。在最近的一项多地点随机试验中，我们证明了认知行为疗法（CBT）可以显著改善青少年JFM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后仍然遭受中度疼痛症状的折磨。有令人鼓舞的证据表明，CBT和体育锻炼相结合可以减轻纤维肌痛（FM）疼痛。不幸的是，由于久坐不动的生活方式加上缺乏适当的身体力学教育，FM患者很难开始和维持定期的中等强度的体育活动。在这个项目中，我们建议开发和测试一种新的青少年纤维肌痛综合训练计划（FIT Teens），该计划将通过结合一种新的神经肌肉计划，改进儿童运动医学/损伤预防方案，从而加强现有的CBT干预。该计划包括综合神经肌肉训练，重点是提高安全参与更多体育活动所需的基本运动技能。该计划的创新特点包括：1)专门设计的神经肌肉训练，以限制可能模仿JFM症状的延迟性肌肉酸痛；2)与CBT的无缝整合，以增强坚持和参与增加的身体活动。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，以影响青少年JFM的疼痛、功能残疾和抑郁症状的关键结果。目的一是测试FIT青少年计划的可行性和可接受性。我们将试行为期8周(16

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].