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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. Common symptoms include:  abdominal pain, blurry vision, chest pain, diarrhea, dizziness, fatigue, headaches, memory deficits, nausea, palpitations, sleep disturbance, and vomiting.  APS can be triggered by stress, illness, or prior injury. Your child’s pain is real, and it can get better. 

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.
Successful treatment for children diagnosed with APS requires focusing on physical function and pushing through the discomfort to retrain the over-firing nerves and blood vessels.  Treatment includes intense exercise and desensitization therapy guided by physical and occupational therapy recommendations, decreasing attention to pain and focusing on performing normal daily activities, as well as stress management. It is important to address ALL aspects to break the pain cycle. Pain and associated symptoms often worsen before getting better and the ability to do normal things usually returns before pain resolves. Often, children/adolescents who have continued pain have not fully addressed the stress component.

Four-prong approach

Intense exercise therapy

  • Perform 45 minutes of aerobic exercise per day, working through pain or discomfort in affected area

  • Perform exercises daily even when experiencing increased pain or muscle soreness 

  • Focus on improvement in function (i.e. speed, endurance, strength, balance)


  • Perform at least 5-10 minutes of desensitization exercises (i.e. rubbing, massaging, heat, cold, vibration, etc.) to affected body part(s), 5 times a day

  • Add desensitization to 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 relaxation 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

  • Work with a counselor or psychologist to deal with stress from pain, school, and all sorts of other normal things

Decrease attention to pain

  • Limit discussion and checking in on pain as this can worsen symptoms

  • Focus on functional/physical activities such as going to school, playing sports, spending time with friends and family, etc.  Keep daily activity consistent, even when experiencing pain

Please note that it is imperative to address all four aspects in order to successfully treat the pain.

Most children are able to get better on their own with these outpatient strategies.  However, some children require more rigorous therapies through interdisciplinary pain rehabilitation.  For those with severe disability who have failed outpatient management, we can escalate the intensity and "dosing" of exercise and stress management through the Rehabilitation for Amplified Pain Syndromes (RAPS) Program.