Amplified pain syndromes in children

Hoffart, C.; Wallace, Dustin P.

doi:10.1097/bor.0000000000000097

Cited by 33 publications

(11 citation statements)

References 77 publications

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“…Although pharmacological and surgical treatments are currently the most common approaches in children and adolescents with chronic pain, future research should be aimed at increasing the knowledge and implementation of multidisciplinary and intensive procedures (Roessler et al, 2016; Zernikow et al, 2012) which include non-pharmacological approaches (support and relationship techniques, behavioral interventions, physical interventions; Cunningham & Kashikar-Zuck, 2013; Hoffart & Wallace, 2014) to introduce more substantial changes in pain management and associated disabilities. There is a need for prospective and interdisciplinary studies to identify the mechanisms that contribute to the development and maintenance of chronic pediatric pain, to perfect interventions that can interrupt these mechanisms, to personalize the treatment of pain, and to control the psychopathological risk of chronic pain, especially in the developmental age.…”

Section: Discussionmentioning

confidence: 99%

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study

Pascali

Matera

Craig

et al. 2018

Clin Child Psychol Psychiatry

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Background: The prevalence of chronic pain is about 30% in children and adolescents which suffer from severe emotional distress. The aim of this observational study is to investigate cognitive, emotional and behavioral consequences of benign chronic pain in children and adolescents suffering of reumathologic diseases. Materials and Methods: A total of 49 participants, chronic pain participants (CPPs) and controls (CGPs), affected by rheumatic diseases, were enrolled. Assessment included collection of sociodemographic data, pain characteristics, and administration of Visual Analog Scale (VAS), Depression Inventory for Children and Adolescents (CDI), Conners’ Parent Rating Scales–Revised (CPRS-R), Child Behavior Checklist (CBCL), and Screen for Child Anxiety–Related Disorders (SCARED). For the statistical analysis, Student’s t-test for independent samples and Pearson’s correlation were used. The significance value was set at p less than .05. Results: A significant difference of mean scores of CBCL items and of CPRS items between the two groups was found. In CPPs, a significant correlation between VAS and mean scores of several CBCL items and between VAS and mean scores of several CPRS items was found. Conclusion: Chronic pain is a real syndrome in which an interdisciplinary treatment should be applied, considering the psychopathological risk, especially in developmental age.

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Section: Discussionmentioning

confidence: 99%

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study

Pascali

Matera

Craig

et al. 2018

Clin Child Psychol Psychiatry

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“…The etiology of JFMS is unknown, but frequently it is seen in the setting of injury, illness, or psychological distress. Hormonal and genetic factors may also play a role [19]. …”

Section: Background and Epidemiologymentioning

confidence: 99%

“…These include topical and oral analgesics and non-steroidal anti-inflammatories (NSAIDs), all of which have been used in the treatment of JFMS but overall are not effective [20]. This lack of efficacy is felt to be due to their peripheral action which provides little benefit for fibromyalgia syndrome given the underlying centrally mediated pain mechanisms [19]. There are no controlled studies reporting the effects of salicylates or other NSAIDs in either adult or JFMS [22].…”

Section: Pharmacologic Managementmentioning

confidence: 99%

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Fibromyalgia: Treating Pain in the Juvenile Patient

Gmuca

Sherry

2017

Pediatr Drugs

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Presently, evidence for the efficacy of medications for the treatment of juvenile fibromyalgia syndrome (JFMS) is limited. While there are medications approved by the US Food and Drug Administration (duloxetine, milnacipran and pregabalin) for adults with fibromyalgia syndrome, there are none for the treatment of JFMS. A variety of medications have been prescribed for the treatment of JFMS, including (but not limited to) non-opioid analgesics, opioids, anticonvulsants, antidepressants, and muscle relaxants. Psychological therapies, most prominently cognitive-behavioral therapy, are the most evidenced-based treatment modalities for JFMS. A multidisciplinary approach, combining pharmacological, behavioral and exercise-based modalities is currently the standard of care for JFMS. In the future, more stringent randomized, controlled trials with longer follow-up periods are needed in order to determine the long-term efficacy and safety of medications in the treatment of JFMS. Additionally, improved recognition of JFMS will allow for better patient recruitment to permit for adequately powered study designs.

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“…Amplified musculoskeletal pain syndrome (AMPS) is a term that encompasses the spectrum of manifestations of chronic pediatric musculoskeletal pain. The common thread underlying these different subtypes is central and/or peripheral sensory pain amplification, hence the name amplified musculoskeletal pain [ 7 ]. The term AMPS is understandable and provides the patient with a mechanism by which to understand and validate the reality of his/her pain.…”

mentioning

confidence: 99%

The spectrum of pediatric amplified musculoskeletal pain syndrome

2020

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Background Children presenting with musculoskeletal pain to pediatric rheumatology clinics are very heterogeneous and on a continuum from those with localized pain to total body pain. Many report intermittent, rather than constant, pain. We examined clinical and psychological characteristics of these children at presentation and specifically those who fulfilled the criteria for fibromyalgia. Methods We performed a retrospective, cross-sectional cohort study of children under ≤18 years old presenting to the pediatric rheumatology pain clinic between January 2015 and July 2019 and enrolled in a patient registry. We included children diagnosed with amplified pain, excluding those fulfilling criteria for complex regional pain syndrome. Abstracted data included clinical characteristics, pain symptoms, functional disability inventory (FDI), widespread pain index, and symptom severity scale. Results We analyzed 636 subjects, predominantly non-Hispanic Caucasian females. Using median split method, 54% had diffuse pain (≥ 5 body regions involved), but, of these, only 58% met criteria for fibromyalgia. Subjects with diffuse pain, compared to those with localized pain had a longer duration of pain (24 vs 12 months, p < 0.01), reported greater pain intensity (6/10 vs 5/10, p < 0.001), greater mental health burden, and poorer function (FDI 25 vs 19, p < 0.0001). Subjects with limited pain more often reported a history of trigger event (34% vs 24%, p < 0.01) but not autonomic changes (14% vs 14%, p = 0.94). The presence of adverse childhood experiences did not differ among those with limited versus diffuse pain except for parental divorce (16% vs 23%, p = 0.03). Intermittent pain was reported in 117 children (18%) and, compared to subjects with constant pain, they reported less pain (0/10 vs 6/10) and were more functional (FDI 13 vs 25) (both p < 0.0001). Conclusions There exists a wide spectrum of pain manifestations among children with amplified pain including limited or diffuse and constant or intermittent pain. Most children who presented to our clinic did not fulfill criteria for fibromyalgia but nonetheless had significant symptoms and disability. Studies focusing on fibromyalgia may miss the full extent of childhood amplified pain. Additionally, research limited to those meeting the fibromyalgia criteria likely underestimate the significant impact of amplified pain among the pediatric population.

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Amplified pain syndromes in children

Cited by 33 publications

References 77 publications

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study

Fibromyalgia: Treating Pain in the Juvenile Patient

The spectrum of pediatric amplified musculoskeletal pain syndrome

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