Amplified Musculoskeletal Pain Syndrome (AMPS), also known as Juvenile Fibromyalgia (whole-body pain) or Complex Regional Pain Syndrome (regional pain), is a complex and immensely painful condition that causes widespread pain in children and adolescents that cannot be explained by injury or illness alone. This pain often causes typically harmless stimuli, such as light touch from clothing or another person, to be incredibly painful. According to the Children’s Hospital of Philadelphia’s (CHOP) Center for Amplified Musculoskeletal Pain Syndrome, AMPS pain can be intermittent or constant, and can affect the entire body or just certain regions (Sherry, D.D., 2020). Besides persistent pain, symptoms of AMPS may include fatigue, trouble sleeping, severe headaches, joint pain, and dizziness. Anxiety and depression have been commonly linked with AMPS as well. AMPS is most commonly diagnosed in preteen and teen girls, especially those with previous anxiety and/or depression (Sherry, D.D., 2001).
Amplified pain follows different neural pathways than typical pain responses in the brain. While normally, damage to a body tissue sends a signal through the pain nerve to the spinal cord, which sends the signal to the brain and is processed as being painful, amplified pain follows an abnormal circuit in the spinal cord, sending pain signals not only to the brain, but also to the neurovascular nerves, which causes blood vessels to constrict. The lack of blood and oxygen causes waste to build up in the muscles and bones, which leads to pain. This cycle continues, leading to an amplification of pain in areas of waste buildup (Sherry, D.D., 2000).
It is believed that a combination of psychological/psychosocial, family, biological, and other factors contributes to AMPS development. While the causes of AMPS are still being studied, there are thought to be three main causes for amplified pain. Severe injury, such as a broken bone, musculoskeletal injury, or significant surgery, may cause AMPS symptoms to develop. While not as common as injury-induced AMPS, illnesses may also cause AMPS to develop. Both inflammatory conditions, such as arthritis, tendonitis, and enthesitis, and infections, such as mononucleosis and influenza, can serve as catalysts for AMPS pain development (Kaufman et al, 2017).
Perhaps the most complex cause of AMPS is psychological stress. While many assume that this stress must be negative, both positive and negative stressors can cause amplified pain. AMPS research has also shown that children with certain personality traits, such as perfectionistic and/or neurotic, are more likely to develop AMPS. Over half of children diagnosed with AMPS have received previous psychological care, indicating a significant connection between psychological symptoms and chronic pain (Sherry, D.D., 2020). Therefore, psychological evaluation of both individual and family dynamics is crucial to understanding AMPS diagnosis and treatment (Sherry, D.D., 2000; 2020).
The presence of AMPS in children has significant neuropsychological implications, including cognitive and psychosocial functioning, physiological development, and psychological well-being. In a study conducted by the Children’s Hospital of Philadelphia’s Center for Amplified Pain, children with AMPS are more likely to present with mental health symptoms, with more than half reporting anxiety, 35% reporting depression, and 22% reporting suicidal ideation. Children and adolescents with AMPS are much more likely to miss multiple days of school, with many missing a quarter or more of a school year (Namerow, 2016). Sleep disorders are also common among those with AMPS, as pain flare-ups are likely to disrupt sleep patterns.
From the perspective of child psychology, AMPS highlights how the emotional and physiological health of children and adolescents interact. Prolonged anxiety is one of the most common causes of AMPS, and AMPS treatment, therefore, consists of intensive psychotherapy to treat the trauma experienced as an AMPS sufferer, as well as potential underlying psychological issues that led to the development of amplified pain. Neuropsychological testing can inform practitioners about the underlying conditions that may exacerbate symptoms, as well as risk factors for the development of AMPS. AMPS treatment also consists of intense outpatient and/or inpatient occupational and physical therapies, including aerobic exercises and desensitization therapies for the reduction of pain responses.
Any additional questions about AMPS and its connection to neuropsychology can be directed to NRS/Lifespan at (732) 988-3441.
Madeline Williams
Student Intern at NRS|LS
Sources Cited
Sherry, D. D. (2000, April). An overview of amplified musculoskeletal pain syndromes. The Journal of Rheumatology. Supplement, 27(58), 44-48. https://www.stopchildhoodpain.org/wp-content/uploads/2020/06/An-Overview-of-Amplified-Musculoskeletal-Pain-Syndromes-2000.pdf
Sherry, D. D. (2001). Diagnosis and treatment of amplified musculoskeletal pain in children. Clinical & Experimental Rheumatology, 19(5 Suppl 23), 617-620.
Sherry, D.D., Sonagra, M., & Gmuca, S. The spectrum of pediatric amplified musculoskeletal pain syndrome. Pediatr Rheumatol 18, 77 (2020). https://doi.org/10.1186/s12969-020-00473-2
Kaufman, E. L., Tress, J., & Sherry, D. D. (2017). Trends in the medicalization of children with amplified musculoskeletal pain syndrome. Pain Medicine, 18(5), 825-831. https://doi.org/10.1093/pm/pnw188
Namerow, L. B. (2016). Pain amplification syndrome: A biopsychosocial approach. Journal of Pediatric Psychology, 41(5), 540–548. https://doi.org/10.1016/j.janxdis.2016.06.027