Amplified musculoskeletal pain syndrome (AMPS) is an illness characterized by notable pain intensity without an identifiable physical cause. [1] [6]
Characteristic symptoms include skin sensitivity to light touch, also known as allodynia. Associated symptoms may include changes associated with disuse including changes in skin texture, color, and temperature, and changes in hair and nail growth. In up to 80% of cases, symptoms are associated with psychological trauma or psychological stress. [3] AMPS may also follow physical injury or illness. [2] Other associations with AMPS include Ehlers-danlos syndrome, myositis, arthritis, and other rheumatologic diseases. [3]
Treatment for notable pain intensity without identifiable pathophysiology can include psychotherapy to alleviate psychological stress. Physical therapists, psychologically informed physical therapists in particular, can coach people on exercises they can do everyday at home. The prognosis for the condition is very positive, with the ability for majority of effected individuals to recover completely, but the management of the condition is a gradual improvement over time, which can leave many individuals feeling a lack of motivation or progress in their AMPS management. Clinicians who use this diagnosis sometimes apply it to children and adolescents. To date, this diagnosis is used more in women. [3] [1]
Amplified musculoskeletal pain is a syndrome which is a set of characteristic symptoms and signs. Essentially, the syndrome is characterized by diffuse, ongoing, daily pain associated with relatively high levels of incapability and greater care-seeking behavior. The discomfort can be in the skin (allodynia), abdomen, throat (dysphagia), headache, and joints. There can be other somatic symptoms such as, movement issues, dizziness, fatigue, stiffness, shakiness, coordination difficulty, swelling, fast heart rate, skin texture, color, or temperature changes, paresthesia, and changes in nail or hair growth. [1] [2] [3] [6] These symptoms are associated with symptoms of anxiety, depression, psychological trauma, and psychological stress. [9] [10]
Findings on examination can include factors associated with disuse including swelling; changes in skin texture, color, and temperature; and changes in nail and hair growth. [3] Other signs of disuse can include muscle atrophy and radiographic osteoporosis. [1]
Various events can cause AMPS. The three main causes include psychological stress, physical injury, and illness. [1] [2] [3] Various other conditions can be risk factors or causes of the disease, including arthritis, myositis, Ehlers-Danlos syndrome, and autoimmune diseases, such as asthma. [1]
Psychological trauma is the main cause of AMPS. Evidence shows it is capable of causing up to 80% of reported AMPS cases. [3] This is often a target of the treatment of AMPS, which includes psychotherapy, occupational therapy, and is one of the reasons for which selective serotonin reuptake inhibitors are used as a management for the condition. [1]
Physical injury, such as a bone fracture or surgery, is the second most common cause, often resulting in complex regional pain syndrome, a type of AMPS that is isolated to one region of the body, such as a hand or foot.
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While AMPS has little research dedicated to it, [6] evidence has showed a mutual cause of condition. The amplified pain is believed to be caused by pain signals sent to the brain, which are also incorrectly sent through the sympathetic nervous system, also known as the "fight or flight" nerves. This causes an involuntary response to pain, including vein constriction. This causes increased heart rate, increase in muscle tone, increased respiratory rate, and a reduce of blood flow to the muscles and bone, resulting in an increase in waste products, such as lactic acid. [1] This buildup of waste products, as well as depletion of oxygen, results in the amplified pain associated with AMPS. [7] This is only a common theory for the cause, and health care professionals and researchers do not have complete evidence of the cause of AMPS, largely do to the lack of research associated with the disorder and its lack of awareness in medicine. [1]
AMPS is classified into four different types, of which may be divided into multiple sub-types. This includes complex regional pain syndrome, diffuse idiopathic pain, intermittent amplified pain, and localized amplified pain. [1]
Complex regional pain syndrome is a term for any amount of spontaneous regional pain lasting longer than the expected recovery time of an observed physical trauma, or other injury. This includes two separate types: type I and type II. Type I CRPS, formerly known as reflex sympathetic dystrophy (RSD) or "Sudeck's atrophy", refers to CRPS without any observed nerve damage. Type II, formerly known as causalgia, refers to CRPS with observed nerve damage. This form, similarly to other forms of AMPS, is known to be able to spread from one limb to a new limb. 35% of people effected with CRPS report full-body impacts from the condition. Common symptoms of CRPS include musculoskeletal pain; swelling; changes to the skin texture, color, or temperature; and limited range of motion. [11]
This type of AMPS includes full-body pain. It is also known as juvenile fibromyalgia.
This type of AMPS refers to amplified pain that varies in intensity over time.
This refers to localized amplified pain without other symptoms. This type cannot include symptoms such as swelling; skin texture, color, or temperature changes; or perspiration. Observation of these symptoms implies the diagnosis of complex regional pain syndrome.
Because of the little awareness on AMPS, the condition is frequently not diagnosed when symptoms first present, often with multiple diagnoses of physical conditions before the diagnosis of AMPS. [3] [12]
The condition is diagnosed through observation of various patient traits. A full overview of the patients medical history, as well as out rule of any potention physical causes, such as a bone fracture. If no physical causes are observed, a diagnosis of AMPS is likely possible. [3] [12] Other common steps that are taken may include bone scans to detect possible signs of reduced blood flow; magnetic resonance imaging (MRI) to detect possible edema, or muscle atrophy; Nerve testing can be used to look for pain or sensitivity issues; and X-rays can detect osteoporosis as the result of AMPS. [1] While all of these tests can detect possible signs of AMPS, better outcomes are usually made with less tests, and immediate treatment of AMPS without looking for possible differential diagnoses. [3]
As AMPS is not a disease, there is no one specific cure for it. [12] Management of the condition is a process of patients learning to manage the abnormal amplified pain. This can include a combination of treating the cause(s) of the condition, as well as managing the symptoms of the condition.
As psychological stress accounts for up to 80% of cases of AMPS, medication often involves typical antidepressants. These are also often prescribed for chronic pain due to the impact they have on serotonin and its impact on muscular pain and control. [8] Many providers also use an injectable medication for treatment of AMPS. Opioid use is not recommended for most AMPS cases, as it can worsen recovery, and in rare cases, make the condition worse. [1]
Physical treatment of AMPS is very common and is shown to have long term benefit. This includes physical therapy, message therapy, and aerobic exercise. Physical therapy involves training the use of the affected limb or training the use of the body. This is for the purpose of retraining muscles after muscle atrophy, and retraining how to use the affected muscles with less amplified pain.
Message therapy is used to desensitize the affected area or body so it can build a tolerance to pain. This can help with symptoms such as allodynia and hyperalgesia in AMPS, as well as indirectly help with other common symptoms by relieving the patient of pain which could have been the cause of psychological stress, depression, anxiety, as well as a number of physiological conditions, including headaches.
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Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.
Complex regional pain syndrome is a severe form of chronic pain, in which pain from a physical trauma outlasts the expected recovery time. The symptoms of types 1 and 2 are the same except type 2 is associated with nerve injury.
Ehlers–Danlos syndromes (EDS) are a group of 13 genetic connective-tissue disorders. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Complications may include aortic dissection, joint dislocations, scoliosis, chronic pain, or early osteoarthritis. The current classification was last updated in 2017, when a number of rarer forms of EDS were added.
Compartment syndrome is a condition in which increased pressure within one of the body's anatomical compartments results in insufficient blood supply to tissue within that space. There are two main types: acute and chronic. Compartments of the leg or arm are most commonly involved.
Tietze syndrome is a benign inflammation of one or more of the costal cartilages. It was first described in 1921 by German surgeon Alexander Tietze and was subsequently named after him. The condition is characterized by tenderness and painful swelling of the anterior (front) chest wall at the costochondral, sternocostal, or sternoclavicular junctions. Tietze syndrome affects the true ribs and has a predilection for the 2nd and 3rd ribs, commonly affecting only a single joint.
Fibromyalgia is a medical condition which causes chronic widespread pain, accompanied by fatigue, waking unrefreshed, and cognitive symptoms. Other symptoms include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and a general hypersensitivity.
Post-polio syndrome is a group of latent symptoms of poliomyelitis (polio), occurring at about a 25–40% rate. These symptoms are caused by the damaging effects of the viral infection on the nervous system. Symptoms typically occur 15 to 30 years after an initial acute paralytic attack. Symptoms include decreasing muscular function or acute weakness with pain and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.
A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.
Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with nausea, sweating, or shortness of breath. It can be divided into heart-related and non-heart-related pain. Pain due to insufficient blood flow to the heart is also called angina pectoris. Those with diabetes or the elderly may have less clear symptoms.
Piriformis syndrome is a condition which is believed to result from nerve compression at the sciatic nerve by the piriformis muscle. It is a specific case of deep gluteal syndrome. The largest and most bulky nerve in the human body is the sciatic nerve. Starting at its origin it is 2 cm wide and 0.5 cm thick. The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the lower limb where it divides into common tibial and fibular nerves. Symptoms may include pain and numbness in the buttocks and down the leg. Often symptoms are worsened with sitting or running.
A shin splint, also known as medial tibial stress syndrome, is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area. Generally this is between the middle of the lower leg and the ankle. The pain may be dull or sharp, and is generally brought on by high-impact exercise that overloads the tibia. It generally resolves during periods of rest. Complications may include stress fractures.
Costochondritis, also known as chest wall pain syndrome or costosternal syndrome, is a benign inflammation of the upper costochondral and sternocostal joints. 90% of patients are affected in multiple ribs on a single side, typically at the 2nd to 5th ribs. Chest pain, the primary symptom of costochondritis, is considered a symptom of a medical emergency, making costochondritis a common presentation in the emergency department. One study found costochondritis was responsible for 30% of patients with chest pain in an emergency department setting.
Polymyalgia rheumatica (PMR) is a syndrome experienced as pain or stiffness, usually in the neck, shoulders, upper arms, and hips, but which may occur all over the body. The pain can be sudden or can occur gradually over a period. Most people with PMR wake up in the morning with pain in their muscles; however, cases have occurred in which the person has developed the pain during the evenings or has pain and stiffness all day long.
Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis) usually affecting adolescents during growth spurts. It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.
Chondromalacia patellae is an inflammation of the underside of the patella and softening of the cartilage.
Myositis is a rarely-encountered medical condition characterized by inflammation affecting the muscles. The manifestations of this condition may include skin issues, muscle weakness, and the potential involvement of other organs. Additionally, systemic symptoms like weight loss, fatigue, and low-grade fever can manifest in individuals with myositis.
Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain in multiple myofascial trigger points ("knots") and fascial constrictions. It can appear in any body part. Symptoms of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.
An accessory navicular bone is an accessory bone of the foot that occasionally develops abnormally in front of the ankle towards the inside of the foot. This bone may be present in approximately 2-21% of the general population and is usually asymptomatic. When it is symptomatic, surgery may be necessary.
Dysesthesia is an unpleasant, abnormal sense of touch. Its etymology comes from the Greek word "dys," meaning "bad," and "aesthesis," which means "sensation". It often presents as pain but may also present as an inappropriate, but not discomforting, sensation. It is caused by lesions of the nervous system, peripheral or central, and it involves sensations, whether spontaneous or evoked, such as burning, wetness, itching, electric shock, and pins and needles. Dysesthesia can include sensations in any bodily tissue, including most often the mouth, scalp, skin, or legs.
Greater trochanteric pain syndrome (GTPS), a form of bursitis, is inflammation of the trochanteric bursa, a part of the hip.