For most people, pain is a temporary (if unpleasant) fact of life – and is the body’s way of saying something is wrong, from a stubbed toe to a more serious systemic illness. But some people experience pain which is out of proportion to the underlying cause, or which happens for no discernible reason at all. For those with amplified musculoskeletal pain, pain may be a daily part of life — even if doctors can’t find a clear explanation for why. Here’s what you need to know about amplified pain and its related conditions, as well as what to do to feel better.
What Is Amplified Musculoskeletal Pain?
In short, amplified musculoskeletal pain is what it sounds like — pain that occurs in the joints, muscles or bones, with no biological explanation (such as injury or inflammation). People with this kind of pain are sometimes described as having AMPS — amplified musculoskeletal pain syndrome. There are lots of different ways that AMPS can present, ranging from pain that occurs in one specific area or body part (called reflex sympathetic dystrophy [RSD] or complex regional pain syndrome [CRPS]), to pain that occurs all over the body (diffuse idiopathic pain). Some doctors feel that fibromyalgia, which can affect adults and children, is also a form of AMPS.
In addition to pain, people with AMPS may have other complaints, including fatigue, trouble sleeping, headaches, abdominal pain, depression, or anxiety. People with RSD/CRPS may have some physical changes in the involved body part, including abnormal color or temperature of the affected area. Allodynia, or extreme pain with light touch, is a common symptom. Fevers, rashes, and joint swelling are not symptoms of AMPS, and should always prompt further workup by a doctor.
When and Why Does AMPS Occur?
AMPS can affect both children and adults, and is more common in females than in males. No one knows exactly what causes AMPS, though there are a number of associated factors. People with RSD/CRPS often have a preceding injury in the affected area; the injury heals, but the pain persists even though there is no longer an acute cause. Hypersensitization of the nerves (either in one body part or all over) may play an important role in causing AMPS.
There is a strong connection between the mind and the body, and people with AMPS sometimes have an underlying psychiatric diagnosis such as depression, anxiety, or an eating disorder. Psychological stressors, including trouble at school, work, and home, can all be triggers for amplified pain. It’s important to remember that people with AMPS aren’t “faking” their symptoms — though there isn’t a clear biological cause, the pain they experience is real.
How is AMPS Treated?
The first step to treating AMPS is getting a correct diagnosis. Many patients with AMPS are seen by multiple doctors, who may order invasive tests and unnecessary medications. Though it may be tempting to keep looking for another underlying cause for the pain, it’s important to realize that AMPS typically does not respond to treatments for inflammation or injury. Remember, fevers, rashes and joint swelling are not signs of AMPS, and should be worked up further.
The best treatment for AMPS is intensive physical and occupational therapy, either outpatient or in a specialized inpatient program. Individual or family psychotherapy and counseling are also important parts of treating AMPS. Some people with AMPS benefit from complementary treatments, including acupuncture, massage, and hydrotherapy. Though certain medications may be effective for some people with fibromyalgia, strong painkillers such as opiates should never be used for amplified musculoskeletal pain. With appropriate care, many people with AMPS improve considerably, and are able to go about their daily lives — without significant pain.
Dr. Sarah Taber is a pediatric rheumatologist at HSS, and is board certified in both pediatrics and pediatric rheumatology. Dr. Taber specializes in the diagnosis and treatment of children with rheumatic diseases, including juvenile idiopathic arthritis, childhood systemic lupus, dermatomyositis, vasculitis, and systemic and localized scleroderma. She is a Consult Editor of Rheumatology for Medscape, and winner of the #1 Consult Case of the Year for 2019. Dr. Taber has also been a featured speaker for the Scleroderma Foundation, Charla de Lupus, and A Lasting Mark Foundation.