Speaker: Susmita Kashikar-Zuck


Dr. Kashikar-Zuck will discuss gaps in the evidence-base for biopsychosocial interventions for pediatric chronic pain and the need to increase innovation and rigor in interventions for chronic musculoskeletal pain. Prior work in cognitive-behavioral (CBT) and related therapies have shown great promise in reducing disability and improving pain. However, the effects of these treatments are modest and not optimized for robust effects on pain reduction and physical activity promotion. The Fibromyalgia Integrative Training program for Teens (FIT Teens) was developed in collaboration with Sports Medicine and combines CBT and progressive neuromuscular exercise training. FIT Teens is conducted in a supportive (in-person or remote) group setting and aims to reduce pain and disability and increase confidence in movement. A large multi-center clinical trial of FIT Teens enrolled over 350 adolescents with juvenile fibromyalgia (JFM) and is nearing completion. Dr. Kashikar-Zuck will present highlights of successfully running a behavioral trial with strong clinical trial rigor (in the context of a global pandemic). Clinical characteristics of this large sample of adolescents with JFM including patient-reported and performance-based outcomes will be discussed as well as engagement with the study and social cohesion in the treatment groups. The talk will include a methodologic primer on the implementation of multicenter trials, centralized data management and monitoring of trial metrics including recruitment, retention, fidelity, adverse events and safety. This large study has provided the infrastructure for a number of ancillary studies of pain mechanisms, executive functioning and pain-related stigma in adolescents with chronic pain. Adaptations of FIT Teens are also being developed for multiple medical conditions such as sickle cell disease and juvenile arthritis. Future research should take a mechanistically informed approach to more effectively treat chronic pain in childhood.


Learning Objectives:
1. Describe how the new FIT Teens intervention addresses gaps in current behavioral treatments for chronic musculoskeletal pain in adolescents.
2. Recognize the characteristic features of JFM and the impact of pain on self-reported and performance-based measures of functioning. 
3. Articulate the key elements required for running a rigorous randomized controlled trial in pediatric chronic pain.