• Amplified Pain Syndromes: What You Should Know


    Amplified pain syndromes (APS) is an umbrella term used to describe increased sensitivity to pain due to abnormal nerve connections in the nervous system. Diagnoses in children that fall under this umbrella term include juvenile fibromyalgia, central sensitization, and generalized chronic pain, among others.

    In combination with a variety of factors, APS may be caused by:

    • Injury
    • Illness
    • Psychological stress

     Individuals with APS may experience:

    • Pain that is localized or widespread
    • An onset of pain that is sudden or gradual
    • Pain with an unknown cause
    • Pain triggered by stress, illness, or prior injury, with pain continuing beyond a typical healing phase
    • Pain described as achy, dull, sharp, shooting, burning, throbbing, and/or stabbing
    • Pain that affects function and the ability to participate fully in daily activities
    • Decreased school attendance, decreased involvement in sports, and disinterest in social participation

    Signs and Symptoms

    • Pain that is heightened in response to a normal event or minor injury that wouldn't typically be perceived as painful
    • Impaired muscle endurance and weakness, poor cardiopulmonary (heart) endurance, poor posture, impaired balance, and/or impaired functional abilities
    • Pain in response to a sensation such as a light touch, pressure, temperature, and/or vibration that would not normally provoke pain
    • Swelling, temperature, and/or color changes to the skin of the affected area

    Other common associated signs/symptoms may include: headache, blurry vision, memory problems, chest pain, heart palpitations, dizziness, abdominal pain, nausea, vomiting, diarrhea, constipation, abnormal limb movements, sleep disturbance, and fatigue.


    Physical therapists work with other medical professionals to provide physical therapy and education for people experiencing APS. Working one-to-one with individuals with APS, physical therapists teach exercises to decrease the fear of movement and apply exposure-based treatments to help desensitize painful areas. They aid in shifting focus from pain to function, encourage the use of stress management strategies, and help people recognize daily causes of stress.

    Treatment may be provided in an inpatient or outpatient setting and may include:

    • Exercise therapy: Daily strengthening and aerobic exercise to retrain the nervous system, decrease the fear of movement, and help people work through pain and discomfort and focus on functional improvements
    • Desensitization: Daily repeated exposure to sensations that are perceived as painful in order to retrain the nerves' response to light touch, pressure, vibration, and temperature
    • Stress education: Guidance about stress management, which may include recommended counseling services, relaxed breathing exercises, mindfulness training, and/or self-regulation strategies
    • Decreased attention to pain: Education on how to limit discussion and decision making  due to pain in order to decrease its importance to the brain, and return to normal daily activities.


    Authored by: Brandi Dorton, PT, DPT, and Danielle Feltrop, PT, DPT, of Children's Mercy Hospital

    Contributors: Cara Hoffart, DO, Rheumatologist, Medical Director of the Rehabilitation for Amplified Pain Syndromes at Children's Mercy Hospital, and Dustin Wallace, PhD, Director of Behavioral Health of the Rehabilitation for Amplified Pain Syndromes at Children's Mercy Hospital


    Hoffart CM, Wallace DP. Amplified pain syndromes in children: treatment and new insights into disease pathogenesis. Curr Opin Rheumatol. 2014;26:592–603. Article Summary in PubMed.