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Amplified Pain Clinic (APS)


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
  • Vomiting

APS can be triggered by stress, illness or prior injury. Your child’s pain is real, and it can get better. 

APS can include:

  • Juvenile primary fibromyalgia syndrome (JPFS).
  • Complex regional pain syndrome (CRPS), formerly reflex sympathetic dystrophy (RSD).
  • Other types of nerve-related pain.

APS treatment


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 of APS 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 to treatment

  • 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).

  • 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.

  • 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.

Complex Pain Clinic


The Complex Pain Clinic promotes and supports optimal comfort, health and functioning for youth with enduring and/or disabling pain by providing high-quality, interdisciplinary care and designing individualized treatment plans. Our multidisciplinary team provides comprehensive physical, behavioral and emotional assessment, and blends conventional and complementary modalities of healing to promote physical ability, empower self-management and enhance quality of life.

Services

  • Pain coping skills

  • Self-regulation training (e.g., self-hypnosis, guided imagery, biofeedback)

  • Cognitive behavioral and acceptance based psychological therapies

  • Headache management

  • Therapeutic massage

  • Physical and occupational therapy

  • Trigger point and painful scar interventions

  • Nerve blocks

  • Pharmaceutical interventions

  • Health behavior education (including sleep hygiene, nutrition, physical activity)

  • Acupuncture

  • Aromatherapy

  • Infusion treatments

  • School support

Conditions

  • Abdominal pain

  • Amplified or centralized pain syndromes:

    • Complex regional pain syndrome (CRPS)

    • Juvenile fibromyalgia syndrome (JFS)

    • Idiopathic pain

  • Chronic back pain

  • Headache/migraine pain

  • Chronic pain related to medical conditions including but not limited to:

    • Musculoskeletal pain

    • Neuropathic pain

    • Juvenile arthritis

    • Cancer

    • Cystic fibrosis 

    • Spina bifida

    • Sickle cell 

    • Muscular dystrophy

    • Epidermolysis bullosa

    • Osteogenesis imperfecta