A multidisciplinary approach that incorporates clinicians, psychologists and rehabilitation specialists and that offers a combination of pharmacological, cognitive behavioral and physical interventions, along with patient education, has been shown to be most effective in treating children and teens with fibromyalgia.
Medications
Medications can help reduce the pain of fibromyalgia and improve sleep. Data on the use of medications in the treatment of juvenile fibromyalgia are limited. However, agents that have shown benefit in adults also have been used in children, and are sometimes effective. Common choices include:
- Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Other antidepressants, such as amitriptyline and fluoxetine (Prozac), are sometimes prescribed and appear to help promote sleep.
- Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Pain reliever such as tramadol (Ultram, Conzip) are also sometimes prescribed. Use of opioids and narcotics should be avoided in treating juvenile fibromyalgia.
- Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are sometimes prescribed for adults to reduce fibromyalgia symptoms.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is an intervention that has been well-studied in the treatment of chronic pain in children, and has been found to help reduce disability and depression. CBT focuses on helping people with fibromyalgia manage their pain using adaptive coping skills. These include the use of relaxation-based treatments, distraction, activity pacing, scheduling pleasant activities, problem-solving, and replacing negative and catastrophic thoughts with more calming and realistic appraisals.
For children and adolescents with fibromyalgia, parents usually participate in some CBT sessions to learn how to coach and support their children's use of these coping skills at home.