There are three major causes for the abnormal reflex in children with amplified musculoskeletal pain syndrome (AMPS): injury, illness and psychological stress. There may be other factors such as age, genetics or hormones (80 percent of children with AMPS are girls).
Injury is the cause of AMPS in approximately 10 to 20 percent of children. The majority of children with post-traumatic AMPS have a significant specific injury such as a broken bone, a crushing or piercing injury or have had surgery. The symptoms of AMPS develop immediately or within a few weeks after the injury. It’s common – as the injury begins to heal – for the pain to start and continue for weeks to months after the injury has fully healed. AMPS can mimic previous pain experiences (e.g., feel like a broken bone, even if the bone has fully healed).
Illness is an infrequent cause of amplified musculoskeletal pain syndrome. It is most commonly seen in conjunction with four inflammatory illnesses of the musculoskeletal system: arthritis, tendonitis, myositis or enthesitis. Other illnesses may be the initial cause of pain; most are infections such as mononucleosis, influenza or gastroenteritis. Constipation can also lead to amplified abdominal pain.
In at least 80 percent of children with amplified musculoskeletal pain syndrome, psychological factors seem to play a role. There is a whole host of possible stressors that may help cause (or perpetuate) AMPS. Stressors can be positive or negative, big or small, and can include not just events, but feelings and personality styles. Many of the stressors that affect AMPS are normal, everyday stressors that all children face. Unfortunately, children with AMPS tend to experience the stress in their bodies as pain, while other children may show their stress in other ways.
One major stressor we see in many children is the psychological consequence of having such severe pain. This frequently is due to others not understanding the nature of the pain (many friends, teachers and family members do not believe the pain is as intense as it is) and also having a delay in diagnosis and multiple failed therapies.
Additionally, all change is stressful, even a change for the good. Feelings such as fear, worry and shyness are stressful, as are the stresses of the events occurring in the world. The most common stresses we see in these children are those that arise from family and school issues. Many families are undergoing changes such as an older sibling leaving home, new jobs or marital issues. School may be more demanding; peer pressure, social demands and social networking can be quite intense.
Many children do not like conflict and have difficulty expressing their opinions, asserting their needs or saying “no” for fear of upsetting others, which can also lead to stressful situations and experiences. Developmentally, most children with AMPS are at a stage where they are gaining more independence and responsibilities; they may be going through puberty, which also increases stress. Some children cope with stress by keeping it inside, and this stress can lead to bodily symptoms including AMPS.
No, not at all. The pain is very real and very intense. Even in those children for whom psychological stress is a trigger or complicating factor, the decreased blood flow to the area of AMPS causes extreme body pain.
Conversion symptoms occur when the subconscious emotional self causes nerve activity or inactivity. The classic example is a child who suddenly goes blind after seeing her dog get run over by a car. In such a situation, the child has no physiologic problems with her eyes or her brain; however, the stress of her experience disrupts the communication between her eyes and brain, resulting in the experience of blindness, without true structural damage. She is truly blind in that her brain does not consciously process any visual information.
Most children with AMPS do not have such a dramatic event leading to their conversion symptoms. Conversion symptoms we commonly see include:
Sometimes the conversion symptom is more of a problem than the pain and is therefore best addressed in a treatment center with a focus on that symptom rather than on pain. For example, a child who experiences a “racing heart” may need to see a heart specialist. We call all of these symptoms “conversion” so there is no confusion with seizures, muscle or nerve damage, or illness.
The vast majority of these symptoms need to be ignored since calling attention to them tends to make them worse. It is a subconscious process and needs to be addressed by working hard in counseling. Physical and occupational therapy by skilled therapists can also be very helpful.
Conversion symptoms that are very entrenched and hard to break generally suggest that stress is playing a large role and needs to be addressed before the conversion symptom will resolve.
Whether it is short- or long-lived, it is important to remember that conversion is subconscious and not voluntary. Up to 40 percent of children with AMPS will have at least one conversion symptom.