Amplified Musculoskeletal Pain Syndrome (AMPS) in Children

What is AMPS in children?

Amplified musculoskeletal pain syndrome (AMPS) is a long-term (chronic) condition that causes severe pain in children and affects their ability to do regular activities. Your child may experience pain all the time in one or more parts of their body, or the pain may come and go.

AMPS sometimes occurs after your child’s body is stressed by something like inflammation, illness or injury. For many children with AMPS, the original cause has healed or gone away, and there’s no ongoing tissue or organ damage. Healthcare providers believe certain nerves that automatically respond to danger or stress become overactive. These overactive nerves cause your child to feel more extreme (amplified) pain.

Most children with this type of pain recover fully with physical therapy and counseling to strengthen their bodies and nervous systems. Early diagnosis is important for effective treatment, so your child can enjoy an active, healthy life.

How is pain different in AMPS?

Children usually experience pain when illness or injury — like a cut or broken bone — causes damage to their bodies. Pain is typically triggered through a sequence of events:

1. Injured tissue sends a signal through pain nerves to your spinal cord.
2. Your spinal cord alerts your brain.
3. Your brain recognizes the signal as pain that you feel.
4. The pain signals go away once the injury heals.

With AMPS, your child’s pain signal takes a different path (short circuit):

1. The signal mistakenly travels to their body’s alarm system to their “fight-or-flight” nerves (autonomic nerves). These control automatic (involuntary) movements like blood flow, breathing, heart rate and muscle tension.
2. Your child’s blood vessels get smaller (constrict).
3. Their smaller blood vessels limit blood flow and oxygen to nerves, muscles and bones. They also lead to a buildup of lactic acid and decreased ability to heal and recover.
4. These factors cause intense, severe pain for your child.
5. The severe pain and inability to participate in activities can lead to secondary issues like weakness, deconditioning, malnutrition and feeling lightheaded or dizzy after a position change.

What are the symptoms of AMPS?

The main symptom of AMPS is pain. Pain may be constant or come and go (intermittent), affecting one or more areas of your child’s body. Your child may develop symptoms of AMPS suddenly or over time, even weeks after experiencing an injury or illness.

Your child may have difficulty using the affected area, or movement may worsen the pain. In some cases, even touching your child lightly can cause pain, which can feel sharp or burning.

Children with AMPS have pain that’s more intense and lasts longer than it should. Other symptoms may include:

• Abdominal pain or nausea.
• Anxiety or depression.
• Difficulty eating or swallowing (dysphagia).
• Dizziness.
• Fatigue.
• Headache.
• Increased sensitivity to touch (allodynia).
• Joint pain.
• Mobility (movement) issues, including stiffness, tremors (shaking) and problems with coordination.
• Swelling (edema).
• Rapid heart rate (tachycardia).
• Skin texture, temperature or color changes.
• Tingling or numbness.

Does my child imagine the pain?

You may wonder if your child really experiences this type of pain, especially if they don’t have an injury or illness. But healthcare providers recommend taking your child’s symptoms seriously. Your pediatrician can make an accurate diagnosis and guide effective treatment.

What causes AMPS in children?

Healthcare providers don’t know the exact cause of amplified musculoskeletal pain syndrome. Your child may develop AMPS symptoms after some type of stressor to the body including inflammation, injury, illness or mental stress. Symptoms may also occur for no known reason.

Age, genetics or hormones may also affect whether your child develops this condition. Tell your pediatrician about any concerning symptoms your child reports, even if you aren’t aware of an injury.

How is AMPS diagnosed?

Diagnosing amplified musculoskeletal pain can be difficult due to its many symptoms that may develop over time. To diagnose AMPS, your pediatrician reviews your child’s medical and family history and asks about recent illnesses, injuries or stressful episodes at school or home.

Your child’s provider also does a physical exam and tries to rule out other causes, like infections or fractures. There’s no blood test for AMPS. But your pediatrician may recommend:

• Bone scans can detect decreased blood flow.
• MRI (magnetic resonance imaging) checks for edema or muscle wasting or thinning (atrophy).
• Nerve tests can look for pain or sensitivity issues. They also check how your child’s peripheral nervous system is working. These are the nerves outside of their brain and spinal cord.
• An X-ray can look for osteoporosis.

What conditions have similar symptoms to AMPS?

Some conditions with similar symptoms are:

• Chronic pain.
• Idiopathic (unknown cause) musculoskeletal pain. This type of pain can be all throughout your child’s body with more symptoms (diffuse) or just in one part (localized).
• Myofascial pain syndrome.

What are the types of AMPS?

There are several types of AMPS based on the type of pain they cause and the area of your child’s body they affect.

They are:

• Complex regional pain syndrome (CRPS).
• Diffuse amplified pain (total body pain or juvenile fibromyalgia), which involves pain in a widespread area and typically causes more symptoms than localized pain.
• Intermittent amplified pain, which features pain that comes and goes.
• Localized amplified pain, which affects one area.

Is amplified musculoskeletal pain syndrome an autoimmune disease?

Healthcare providers don’t think that AMPS is an autoimmune disease. But children with autoimmune diseases, like asthma, are more likely to develop AMPS.

How is AMPS treated?

Treatment for AMPS involves pain management and retraining pain pathways so they properly signal pain. Your pediatrician works with you and your child to restore your child’s ability to participate in daily life.

While pain medications can help symptoms, they don’t cure AMPS. Medications can help your child to participate in treatment and be active in their daily life. Treatment involves improving your child’s daily life functioning and returning to school, social and physical activities.

In most cases, you can treat AMPS at home or as an outpatient. Some children with severe symptoms or underlying medical conditions may require inpatient treatment.

Pain management typically includes intense:

• Aerobic exercise.
• Massage therapy, so physical contact begins to feel less painful (desensitization).
• Occupational therapy.
• Physical therapy.
• Psychotherapy (talk therapy).
• Medications.
• Procedures and injections.

Other treatments, including wellness and relaxation techniques, may help your child. These include:

• Biofeedback.
• Mindfulness.
• Music therapy.
• Yoga therapy.
• Dietary changes.

Who might be on my child's care team for AMPS?

A skilled team of specialists typically works with you and your child to diagnose and treat AMPS. Your child’s care team may include your pediatrician and a:

• Pediatric pain specialist.
• Child psychologist or psychotherapist.
• Massage therapist.
• Occupational therapist.
• Physical therapist.
• Recreational therapist.
• Yoga/music therapist.
• Nurse.

How long will AMPS treatment last?

Treatment depends on your child’s symptoms and their severity. In some cases, your child may need only a few weeks of therapy. In more severe cases, treatment can last for many weeks.

Stress and other factors at school or home may contribute to your child’s symptoms. In this case, your child may need ongoing counseling to maintain good physical and mental health.

Can AMPS be prevented?

Although some life events may trigger AMPS, it’s not possible for your child to avoid all stress, injuries and illnesses throughout their life. The best way to care for your child is to see your provider if your child complains of pain that doesn’t get better.

If you notice unusual symptoms in your child, even if they haven’t had a recent illness or injury, see your pediatrician. Healthcare providers can check your child and figure out the right diagnosis and treatment.

Who is affected by AMPS?

Amplified musculoskeletal pain syndrome can affect anyone. It mostly occurs in children and adolescents, especially those assigned female at birth (AFAB).

How common is AMPS?

Children often experience musculoskeletal pain that isn’t caused by swelling (inflammation). Healthcare providers don’t know the exact number of children with AMPS, but it’s one of the most common types of noninflammatory musculoskeletal pain. Its broad symptoms can make it difficult to diagnose.

What can I expect if my child has AMPS?

With treatment, your child gradually returns to daily activities but may continue to feel pain. Pain usually gets worse with treatment before it gets better and may not resolve for several months. Function usually has to improve first before pain improves.

Your pediatrician works closely with you and your child to ensure that treatment progresses as it should. Talk to your child’s care team if you have any questions or concerns.

When can my child return to school and other activities?

Many children can attend school and participate in other activities once a treatment plan is in place. Talk to your pediatrician about the best timeline for your child.

What is the outlook for AMPS?

In most cases, children who receive intensive treatment for AMPS fully recover. Some may experience mild pain or pain that occurs again (recurrent pain). Few children need repeat treatment.

When should I seek care for my child?

Talk to your pediatrician if your child develops new or worsening symptoms. While AMPS pain usually gets worse before it gets better during treatment, alert your provider if you have concerns or questions. Your child’s care team can support you and your child in your health journey.

A note from Cleveland Clinic

It’s hard to see your child in pain, and it can be frustrating when you don’t know what caused the pain or how to treat it. Amplified musculoskeletal pain is a painful condition that develops when nerves don’t properly signal pain. Your child’s symptoms may arise over a period of weeks, making it difficult to diagnose. But effective treatments are available. Treatment often combines physical therapy, exercise and counseling. Medications can help with symptoms to allow your child to return to functioning. With the support of an experienced and compassionate care team, most children with AMPS recover over time to enjoy full, healthy lives.