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Amplified Musculoskeletal Pain Syndrome

Amplified musculoskeletal pain syndrome (AMPS), also known as childhood or juvenile pain amplification syndrome, occurs when the body responds abnormally to harmless stimuli (such as touch or pressure) and interprets them as pain.

AMPS can affect a single part of the body or affect the entire body. Examples of the former include reflex sympathetic dystrophy syndrome and complex regional pain syndrome. AMPS associated with total body pain is called juvenile fibromyalgia (also known as juvenile primary fibromyalgia or pediatric fibromyalgia).

Triggers for amplified pain include injury, illness and psychological stress, but children with AMPS do not have an underlying inflammatory condition. Pain amplification is more common in teenagers, girls and those with anxiety or depression.

Symptoms

Children may complain of pain in one specific region, such as a limb, or they may have generalized pain in the muscles, joints and bones throughout the body. Other symptoms that are not specific for this condition include fatigue, trouble sleeping, headache, abdominal pain, depression, anxiety or tension. If the pain is localized to a limb, the child may experience color and temperature changes in the affected areas. These are known as “autonomic changes.” Many children also experience “allodynia,” an abnormal sensation of pain caused by light touch. Children with AMPS do not have obvious physical symptoms such joint swelling, fevers or rashes.

Diagnosis

The diagnosis is largely based on a thorough review of the patient's medical history, including both physical symptoms and psychological or emotional concerns. An physical exam may identify specific locations of pain and autonomic changes, but there will be no signs of joint inflammation. Often, a doctor will order blood tests to rule out other causes of pain.

Treatment

The goal of treatment is to break the pain cycle so that the child can resume a normal life. A multidisciplinary approach is taken:

  • education
  • aerobic exercise
  • physical therapy
  • desensitization therapies
  • individualized outpatient psychotherapy for coping strategies and stress management

Eliminating some medications and teaching the child techniques to improve sleep and can also help. Amplified pain should never be treated with opioids or other strong painkillers, as these medications may be addictive, and do not treat the underlying cause of the pain.

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