If your child has been diagnosed or is suspected to have amplified musculoskeletal pain syndrome (AMPS), you likely have a lot of questions. This page, as well as the AMPS condition page, will help you better understand the condition, how an accurate diagnosis is made and what treatment options are available.

If you have specific questions about your child’s condition or care, please speak to their care team or request an appointment with CHOP’s Center for Amplified Musculoskeletal Pain Syndrome by completing our patient intake form.

Can the pain get worse or spread?

Yes. In addition to muscle soreness, it is common for AMPS pain and associated symptoms to get worse or spread to new areas of the body once your child begins physical activity and desensitization. Increased pain and pain in new areas are generally regarded as positive because this shows that the nerves are reconnecting and will soon function normally. For AMPS patients, pain often gets worse before it gets better.

How can stress make AMPS worse?

Stress can cause your child’s muscles to tense or spasm, which increases pain. Additionally, when your child feels stressed, their levels of the hormone cortisol rise. In general, stress exists in two categories: distress (things that negatively affect you) and eustress (things that have a positive effect on you).

• Living with chronic pain frequently means that patients no longer have access to natural or preferred stress relievers
• A focus on pain tends to increase one’s experience of pain
• Difficulty managing pain can relate to a decrease in frustration tolerance and an increase in anger and/or sadness

How does talking to a psychologist make pain better?

Working with a psychologist makes the pain better in several ways:

• It provides a way to understand how stress and pain are related.
• Exploring and identifying stressors can help reduce the impact of stress and, therefore, help decrease pain.
• Talking about coping mechanisms helps prepare your child to use these strategies when they are experiencing pain, which can help decrease pain. Coping strategies can include techniques such as: deep breathing, visualization, distraction and other cognitive-based strategies.

My child does well in everything; what could they be stressed about?

Stress not only comes from negative experiences or situations, but also comes from times when we are happy and doing well or during times of change. Many people also experience stress when managing several different activities at one time. This can be even more challenging when a person likes and/or is good at all these activities and has difficulty prioritizing time and energy for certain activities. Many people are very busy enjoying multiple activities and feel pressure to continue succeeding at each, which can be especially stressful for people who have tendencies toward perfectionism.

If I don’t ask about my child’s pain, they will think I don’t care. How is that helpful?

Research shows that paying attention to pain — such as asking how your child is feeling, asking for pain ratings, asking what the pain feels like, saying you hope your child feels better — makes pain worse. Encouraging patients to think how to cope through pain is often more helpful.

For example, pain tends to decrease when caregivers respond to children by distracting their attention to other things like participating in activities or talking about other subjects. It is important to let your child know you care about them and you want them to feel better, and therefore you will no longer be asking about or responding to complaints of pain because you know it is best for them.

Acknowledging how hard your child is working in treatment, functional improvements you observe, and that you are proud of the child are great ways to show you care without paying attention to pain.

When will the pain from AMPS go away?

Each patient is different and so is their treatment timeline. Patients will make progress functionally before their pain starts to go away. We see that patients start to experience pain reduction once they work to improve their level of functioning and can engage in normal activities despite pain.

At that point, patients often see a gradual reduction in pain, especially if they are not thinking about the “ifs and whens” of the pain going away. Focus on pain will only keep the pain around for longer, but it can be challenging to remove the focus on pain during treatment. One of the many benefits of cognitive behavioral therapy is that patients learn skills to cope with pain and strategies to help them think less about pain while processing the challenges of treating their amplified pain.

Will my child’s AMPS ever recur?

Each patient is different and so is their recovery. Some patients do experience recurrences of pain but are usually able to address this pain quickly if they reengage in their AMPS treatment strategies.

If pain recurs, your child will use the same skills and techniques to treat their pain as they did the first time. The AMPS team is happy to see you for follow up in clinic or answer questions even if you have not been seen by our team in a while.

In general, we do not continue to follow up with patients once they have treated their pain as there is no need for continued monitoring once AMPS is treated. Although we don’t routinely follow up long term as our patients don’t require long term care after treatment, we are happy to reengage in your child’s care if an issue arises.

Is there anything I need to tell my child’s other medical providers?

When visiting other providers, you do not necessarily need to tell them about your child’s diagnosis of AMPS, however it may be helpful to ask them what is typical for what your child is seeing them for. For example, if your child is having a procedure, it is helpful to know what the typical healing time is for that procedure. By knowing this, you will be able to understand that if your child is experiencing discomfort for longer than typical, it could be their AMPS playing a role and then your child can use the skills they’ve learned to manage that discomfort.

What AMPS programs and services are available at CHOP?

CHOP’s Center for Amplified Musculoskeletal Pain Syndrome offers three levels of care for patients with AMPS:

• A multidisciplinary consultative clinic
• Outpatient treatment
• Therapeutic hospital treatment program

In addition to medical care, your child may also benefit from support from:

• Psychology and social work
• Physical and occupational therapy
• Creative arts therapy
• Educational support

Reminder

As a reminder, a consultation with the Center for Amplified Musculoskeletal Pain Syndrome is not appropriate for every patient. We do NOT treat patients with the following conditions unless their primary complaint is chronic pain:

• Neuropsychiatric illness (functional neurologic disorder or conversion disorder, suicidality, disordered eating, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
• Post-infectious illness (e.g., long-haul COVID-19, posttreatment Lyme disease syndrome, chronic fatigue syndrome)
• Autonomic dysfunction or postural orthostatic tachycardia syndrome (POTS)
• Ehlers-Danlos Syndrome

We also do not treat:

• Mast cell activation syndrome
• Pediatric cancer pain
• Sickle cell disease
• Mitochondrial disease
• Functional abdominal pain requiring parental nutrition (e.g., tube feeds)