Managing Complex Pain in Children: Information for Referring Physicians

Supporting medical providers and their pediatric patients with amplified musculoskeletal pain syndrome

The Center for Amplified Musculoskeletal Pain Syndrome at Children’s Hospital of Philadelphia (CHOP) provides a comprehensive resource where clinicians can turn for advanced diagnostics, targeted therapies and individualized treatments for their pediatric patients with amplified pain.

Amplified musculoskeletal pain syndrome (AMPS) is an umbrella term for a few chronic non-inflammatory musculoskeletal pain conditions that can affect the whole body or be localized to one limb or part of the body. AMPS is chronic musculoskeletal pain caused by overfiring of the nerves designed to protect the body from injury. These nerves go “haywire” and produce a constant pain cycle, resulting in pain hypersensitivity or nociplastic pain that is non-responsive to traditional treatments.

Our program provides holistic, interdisciplinary non-pharmacologic treatment grounded in a biopsychosocial framework for amplified pain. Our outpatient team is comprised of a general pediatrician, pediatric rheumatologist, nurse practitioner, psychologists, physical and occupational therapists, and a social worker.

Who we treat

We treat patients who:

  • Are younger than 17 years old
  • Have chronic pain conditions such as: chronic widespread pain (CWP); chronic idiopathic pain; fibromyalgia syndrome; complex regional pain syndrome; chronic, refractory head pain (e.g., migraines)
  • Have chronic pain with comorbid chronic medical conditions that are otherwise in remission (e.g., juvenile idiopathic arthritis, inflammatory bowel disease, etc.)

Who is not appropriate for referral?

Consultation with the Center for Amplified Musculoskeletal Pain Syndrome is not appropriate for every patient. We do NOT treat patients with the following conditions unless their primary complaint is chronic pain:

  • Neuropsychiatric illness (functional neurologic disorder or conversion disorder, suicidality, disordered eating, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)
  • Post-infectious illness (e.g., long-haul COVID-19, post-treatment Lyme disease syndrome, chronic fatigue syndrome)
  • Autonomic dysfunction or postural orthostatic tachycardia syndrome (POTS)
  • Ehlers-Danlos Syndrome

We also do not treat:

  • Mast cell activation syndrome
  • Pediatric cancer pain
  • Sickle cell disease
  • Mitochondrial disease
  • Functional abdominal pain requiring parental nutrition (e.g., tube feeds)

View our Amplified Musculoskeletal Pain Syndrome condition content for more information on symptoms and treatment for AMPS.

When to Partner with CHOP’S AMPS Program

  • Your patient has diffuse or localized amplified pain or constant or intermittent pain with no known cause
  • Your patient has complex regional pain syndrome
  • You desire a coordinated, multidisciplinary evaluation and treatment plan for your patient

How CHOP can support you and your patients

If you have a patient with diagnosed or suspected AMPS, we want to hear from you. We welcome the opportunity to partner with you to better understand your patient’s condition, any causative or contributing factors, and to collaborate in developing an individualized treatment plan that will restore the child’s overall health.

Most AMPS patients can be successfully treated with outpatient services and follow up with our pain clinic every 3-4 months. For patients who need more intensive services, a therapeutic intensive interdisciplinary treatment program is also available at CHOP.