Post-Discharge Information for AMPS Treatment

The primary focus of Phase I of treatment for amplified musculoskeletal pain syndrome is to help your child regain function performing their activities of daily living – which for most patients at CHOP includes school, sports, leisure activities and family responsibilities.

Build on progress made

As patients transition to Phase II, the goal of treatment changes to build on function gained in Phase I using the tools and experiences gained to independently maintain function. If pain has not decreased or resolved during Phase I, it is expected that pain will lessen during Phase II.

Typical recommendations in Phase II include:

• Return to school.
• Return to all activities the patient enjoys.
• Return to peer relationships and socializing.
• Resume “normal” activities and responsibilities at home (such as chores, sleeping schedules, sleeping places, roles in the family).
• Do not make decisions about whether to do activities based on pain or fear of pain (or anxiety/fear of anxiety). Patients are encouraged not to change plans based on pain.
• Stay active based on recommendations from the PT & OT staff. Typically, this means participating in activities the patient enjoys such as sports, clubs, walking the dog, etc. The type and intensity of activity is dependent on the patient’s interests and goals. We understand that not all patients want to participate in sports or other formal physical activities, and we want patients to choose how to remain active based on what they enjoy.
• Psychological counseling for all patients after discharge. Our AMPS psychologists can coordinate care with an outpatient provider.
• Family or parental counseling as recommended.

We want patients to take responsibility for Phase II recommendations. We encourage patients to take responsibility for being active at an appropriate level. This responsibility should not fall on the parents.

Patients are welcome to include family members in the activity, such as planning a family hike, but the patient needs to take responsibility for their own physical activity.

Addressing a pain relapse

If your child has a relapse of AMPS:

• Continue with all normal activities (including regular school attendance, sports, chores, etc.) and use strategies learned during AMPS Program treatment at CHOP to cope with the pain.
• Do not rest, change plans or make other accommodations because of pain.
• Avoid immobilization or use of pain medications to treat AMPS pain.
• Note: If an orthopedic injury occurs (such as a fracture), the orthopedic injury must be treated first (for example, with casting) but AMPS-focused treatment should resume as soon as the orthopedic injury has healed. For example, if a fracture occurs and the treating provider indicates that pain is persisting despite healing of the fracture, you may want to consider AMPS focused interventions at that time.
• Pay attention to the stresses in life and resume counseling (talking about feelings and stressors).
• Contact the CHOP AMPS Program treatment staff with any questions or consult with treatment providers in the community, as appropriate.

Outpatient Counseling

When families look for a psychologist in their communities for treatment after therapy, they often want their insurance to cover the cost. We recommend that you contact your insurance company to obtain a list of participating providers in your area.

In general, referrals from insurance panels are good referrals. Local pediatricians, psychiatrists, schools, and community members can also be good referral sources; however, they likely do not have information regarding your insurance coverage. Another great resource for finding outpatient counseling providers near you is Psychology Today.

Recommendations for selecting a psychologist:

• Patients are encouraged to ask their insurance company for a list of participating psychotherapists (psychologists, clinical social workers) who work with children/adolescents or with families and use cognitive behavioral therapy (CBT) techniques.
• The most important thing is that the patient and/or family like the therapist(s) they select. This is above and beyond anything else! If patients don’t like the therapist, they are unlikely to talk in therapy and will not progress well.
• We do not typically recommend patients seek therapists who specialize in pain management. Instead, the focus should be on exploring stressors, emotional difficulties, personality factors and family dynamics may cause or maintain pain. Patients frequently benefit from learning relaxation techniques and pain coping skills early during treatment. Overall, we do not recommend that pain be a primary discussion topic in treatment.
• If a family is looking for both individual therapy for a patient and family therapy, we recommend that two different therapists provide these services.
• It may be helpful to refer psychotherapists to CHOP’s Center for Amplified Musculoskeletal Pain Syndrome website to help them learn more about AMPS. Our AMPS Program psychologists are also happy to consult with an outside provider, once the patient has identified a provider they like. Consultation will allow our psychologists to provide background on amplified pain and support your child’s treatment.
• Please contact the AMPS Program with questions or to coordinate care between your local psychologist and a CHOP psychologist by sending a MyCHOP message.

Frequently asked questions about discharge from the AMPS program?

When will I find out about my child’s progress and discharge?

On Thursday mornings, the AMPS team meets to discuss the progress of each patient in the program and their plans of care, including discharge. Patients are typically discharged when they are fully functional — not necessarily when they are pain-free.

The team will contact you once a discharge date is determined, typically on a Thursday or Friday. We wait to share the discharge date with the patient until caregivers are notified. Families typically receive notice the week before discharge, such as notification on Thursday or Friday for discharge the following week.

What happens if my child or I don’t feel they are ready for discharge when the clinical team thinks they are?

The team’s decision to discharge a patient from the program is not entered into lightly, and many factors are weighed and discussed by the team before determining the date. Often caregivers and patients feel nervous about discharge, especially if patients are not pain-free, but discharge from the program is an essential part of continued progress in treatment. Many patients see more gains once they return to their normal activities, including school. It is not uncommon or worrisome if pain and associated symptoms increase just prior to discharge due to stress related to transitioning out of the program.

When will the pain go away?

There are three distinct phases of AMPS treatment at Children’s Hospital of Philadelphia for children who require our intensive and therapeutic hospital treatment program:

• Intensive therapy
• Discharge and return to typical activities
• Maintenance

Visit this page to learn about each phase, how parents can support their children throughout the process, and address emotional support issues that may need to be dealt with during the healing process.

What is expected of patients once they are discharged from the program?

When patients are discharged from the AMPS Program, they will be given recommendations specific to their needs. Patients are expected to return to school full-time without physical or pain-based accommodations and it is generally recommended that patients return to previous sports or clubs they enjoy. Individual and/or family psychotherapy is also recommended following discharge. Patients do not return to outpatient PT or OT after discharge, the only continued formal treatment we recommend is counseling with a cognitive behavioral therapy provider.

Will my child’s AMPS ever recur?

Each patient is different and so is their recovery. If pain recurs, your child’s experience in the program has equipped them with the knowledge and skills needed to reduce it. If you have any questions about recurring pain or treatment, please reach out to the AMPS team via MyCHOP.