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Rheumatology Treatment Guidelines for Children with Amplified Pain Syndrome
Rheumatology Treatment Guidelines for Children with Amplified Pain Syndrome

Amplified Pain Syndrome (APS) can include: Juvenile Primary Fibromyalgia Syndrome, Complex Regional Pain Syndrome (CRPS) (formerly Reflex Sympathetic Dystrophy (RSD)), and other types of nerve-related pain.

What Is Amplified Pain Syndrome?

Amplified pain syndrome (APS) is a condition in which the child’s perception of pain is increased due to the abnormal firing of nerves which sense pain and control vascular tone. Pain can be localized to one area of the body, can be generalized throughout the body, and sometimes includes other physical symptoms in addition to pain. APS can be triggered by stress, illness, or prior injury. Your child’s pain is real, and it can get better. 

Treatment Options

Successful treatment for children diagnosed with APS includes; intense exercise and desensitization therapy guided by physical and occupational therapy recommendations, as well as stress management. It is important to address all aspects (intense exercise, desensitization, and stress management) in order to break the pain cycle. Pain often worsens before getting better and many times, functional ability returns before the pain resolves. Frequently, children/adolescents who have continued pain have not fully addressed the stress component.

A Three-Prong Approach

Intense Exercise Therapy

  • Perform 45 minutes of aerobic exercise per day, working through pain or discomfort in affected area (15 minutes of cardio and 30 minutes of exercises provided in home exercise program)
  • Perform exercises daily even when experiencing increased pain or muscle soreness 
  • Focus on improvement in function 


  • Perform at least 5-10 minutes of desensitization exercises (provided by therapist) to affected body part(s), 5 times a day
  • Incorporate desensitization into exercises by standing or laying on textured surfaces (scratchy rug, fake grass mat, bumpy surface, various fabrics, etc.)
  • Incorporate desensitization activities into daily routine when possible (i.e. towel rub and lotion massage following shower)

Stress management

  • Practice deep breathing, imagery, and other relaxation techniques to work through pain and provide daily opportunities to unwind
  • Learn ways to incorporate coping strategies (such as journaling, creative writing, drawing, listening to music, etc.) into everyday life
  • Discuss underlying stress with counselor or psychologist

It is imperative to address all three aspects in order to successfully treat the pain.


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