Pediatric amplified musculoskeletal pain syndrome (AMPS)

What is pediatric amplified musculoskeletal pain syndrome (AMPS)?

AMPS, amplified musculoskeletal pain syndrome, is a condition in which pain signals that are traveling from the spinal cord to the brain are misread and intensified. This overactive pain signal can cause constriction of blood vessels, which deprives oxygen in muscles, bones, and skin causing acid build up. In turn, a mild pain signal is amplified into a very painful signal.

Pain can occur in just one area of the body, or can be in multiple locations. We do believe the pain is real for your child, and that it can get better. 

Amplified pain syndrome can encompass multiple diagnoses including: complex regional pain syndrome (CRPS), reflex sympathetic dystrophy (RSD), central sensitization pain syndrome, and any other nerve related pain.

Many times, children with AMPS, have difficulty going to school, participating in activities they once enjoyed, start spending less time with friends, and can become more anxious and depressed. For this reason, the treatment for AMPS is a multimodal approach. This includes: physician, intense physical therapy (PT), and psychological counseling.

What are the signs and symptoms of pediatric amplified musculoskeletal pain syndrome (AMPS)?

Signs and symptoms may include but are not limited to:

• Pain in one or multiple limbs, abdomen, head, or whole body

• Sensitivity to touch/allodynia (pain in response to a stimulus that is not normally painful)

• Skin color changes (blue, purple, red)

• Skin temperature changes

• Swelling to the affected area

• Changes in hair or nail growth

How is amplified musculoskeletal pain syndrome (AMPS) diagnosed?

There is not one specific test that will indicate AMPS. Many children have seen several different specialists before seeking treatment in the chronic pain clinic. However, MRIs and x-rays are usually done prior to the child’s appointment, and results are reviewed by our pain management physicians. At this point, the focus is now on starting treatment for AMPS, and not continuing to seek more diagnoses.

What are the causes of pediatric amplified musculoskeletal pain syndrome (AMPS)?

The three primary causes of AMPS are, but not limited to:

1. Injuries can also lead to AMPS. Many children who have had an injury continue to have intense pain, even after the tissue or bone has healed. There is not an identified problem with lab studies or imaging studies, yet the patient continues having pain. 

2. Psychological stress is the most frequent cause of AMPS, up to 80% of cases. Examples of stress in our patients could be family situations, past trauma, school, and different changes in a child or adolescent’s life. This psychological stress can manifest itself as increased pain.

3. Illnesses such as arthritis, myositis, Ehlers-Danlos, and other rheumatologic diseases can increase the likelihood of AMPS. 

Other factors may include genetics, hormones and age. No matter what the cause for AMPS, the treatment still remains the same.

Risk factors

AMPS affects females more often than males.

How is pediatric amplified musculoskeletal pain syndrome (AMPS) treated?

The treatment for amplified pain involves a multi-modal approach, focused on rehabilitation and improved functioning. This typically involves: a physician, physical therapy (PT), and psychological support.

Research shows that this approach to helping chronic pain is what can help restore function and improve the pain. Oftentimes, functionality will improve prior to the pain.

We understand that parents can be very worried and concerned for their child who is in constant pain. As part of moving forward and treating AMPS it is recommended that there is a decrease in the attention to the pain. Talking about the pain can actually make the healing process worse. The focus should now be on function, improvement, and the child’s daily activities. 

Psychological counseling can help address this more, and the therapist can help the family change their focus off of the pain.