Kashikar-Zuck, S; Black, WR; Pfeiffer, M; Peugh, J; Williams, SE; Ting, TV; Thomas, S; Kitchen, K; Myer, GD. Pilot Randomized Trial of Integrated Cognitive Behavioral Therapy and Neuromuscular Training for Juvenile Fibromyalgia The FIT Teens Program. Journal of Pain. 2018; 19(9):1049-1062.
This paper presents the results of a pilot randomized trial of a novel intervention, the Fibromyalgia Integrative Training (FIT Teens) program for adolescents with juvenile fibromyalgia, a complex chronic pain condition associated with high levels of impairment. The treatment program is an 8-week, 16-session outpatient treatment which combines cognitive-behavioral therapy techniques with neuromuscular exercise training – an approach derived from injury prevention research. Sessions are delivered in a group-based setting and led by a psychologist and an exercise trainer. The FIT Teens program led to significantly greater reduction in pain compared to a cognitive-behavioral therapy only condition. FIT Teens also resulted in significantly lower disability at the end of treatment. The findings of this study laid the foundation for a large multi-site randomized clinical trial (NIH R01) that is being implemented across 7 centers in North America.
McGrady, ME; Holbein, CE; Smith, AW; Morrison, CF; Hommel, KA; Modi, AC; Pai, AL H; Ramsey, RR. An Independent Evaluation of the Accuracy and Usability of Electronic Adherence Monitoring Devices. Annals of internal medicine. 2018; 169(6):419-422.
Electronic adherence monitoring devices (EAMDs) permit the evaluation of patterns of medication use to determine a patient’s level of adherence. Although EAMDs are the most objective measurement strategy and considered the “gold standard” for clinical practice, these devices are typically only tested by the manufacturing company and do not undergo independent accuracy testing. We used a true experimental design to conduct independent testing of the accuracy of 10 different EAMD types. The percentage of accurate and captured registrations varied from 64%-100%, however, 95% of the device openings and recorded opening times were within 1 minute of the actual opening. Publishing a critical review of electronic adherence monitoring devices, using an experimental design, allows clinicians and researchers to consider the characteristics of their population and to pick the most accurate and appropriate EAMD. The Adherence Center at Cincinnati Children's Hospital Medical Center often sets the standard for adherence measurement and intervention and this paper contributes to the scientific literature with experimental data to more rigorously evaluate electronic adherence monitoring devices.
Kashikar-Zuck, S; Cunningham, N; Peugh, J; Black, WR; Nelson, S; Lynch-Jordan, AM; Pfeiffer, M; Tran, ST; Ting, TV; Arnold, LM; Carle, A; Noll, J; Powers, SW; Lovell, DJ. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain. 2019; 160(2):433-441.
Research findings presented in this paper are from the first systematic long-term follow-up study of adolescents with juvenile fibromyalgia (JFM) into adulthood (study funded by NIAMS R01 Kashikar-Zuck PI). Results showed that the vast majority of youth with fibromyalgia continue to experience symptoms that are persistent into adulthood, challenging prior misconceptions that youth with JFM will “simply grow out of it.” Using sophisticated statistical longitudinal analysis, we further showed that patient outcomes with respect to pain and mood symptoms follow distinct trajectories from adolescence to adulthood. The trajectory subgroup of patients with the highest risk of physical disability in adulthood were those who showed a pattern of increasing depressive symptoms over the years. The years of transition to adulthood were found to be of key importance. This study provides new information relevant to clinical care and follow-up for teens with fibromyalgia with particular emphasis on early assessment, monitoring and intervention for emotional adjustment as an important component of treatment.
Nahman-Averbuch, H; Leon, E; Hunter, BM; Ding, L; Hershey, AD; Powers, SW; King, CD; Coghill, RC. Increased pain sensitivity but normal pain modulation in adolescents with migraine. Pain. 2019; 160(5):1019-1028.
One of the major challenges of understanding various forms of chronic pain is determining pre-disposition. In this study, we carefully constructed pain phenotypes of adolescents with migraine, healthy volunteers with no family history of migraine, and healthy volunteers with a family history of migraine. We expected that adolescents with migraine and family histories of migraine would have lower efficacy of conditioned pain modulation – a phenomenon where pain from a test noxious stimulus is inhibited by a spatially remote (conditioning) noxious stimulus – relative to healthy controls. Surprisingly, there were no differences - we found that the healthy controls were less sensitive to noxious heat stimuli than either the adolescents with migraine or the adolescents with a family history of migraine. These findings indicate that basic nociceptive processing mechanisms are altered in individuals with a family history of migraine, while mechanisms associated with pain modulation are relatively normal. Detailed quantitative sensory testing to further elucidate these altered nociceptive processing mechanisms may provide a valuable tool for early prediction of migraine risk.