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. 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; changes in nail and hair growth, muscle atrophy, and radiographic osteoporosis. [1] [3]
It's not possible to discuss causes when there is no objectively verifiable pathophysiology. It's more accurate to describe when patients and clinicians might find this diagnosis appealing.
Psychological trauma is strongly associated with unexplained pain conceptualized as AMPS. [3]
The combination of physical injury, such as a bone fracture or surgery, and over protectiveness and disuse can be referred to as complex regional pain syndrome, a type of AMPS that is isolated to one region of the body, such as a hand or foot.
Asthma, autoimmune diseases, arthritis, myositis, Ehlers-Danlos syndrome, rheumatologic diseases, being female.
AMPS is theoretical rather than experimental. [6] The amplified pain is conceptualized as incorrect sympathetic nervous system signals 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]
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, massage 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.
Massage 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 general medical term used to describe a 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 certain types of arthritis, other organs such as the skin are also affected. Onset can be gradual or sudden.
Complex regional pain syndrome, sometimes referred to by the hyponyms reflex sympathetic dystrophy (RSD) or reflex neurovascular dystrophy (RND), is a rare and severe form of neuroinflammatory and dysautonomic disorder causing chronic pain, neurovascular, and neuropathic symptoms. Although it can vary widely, the classic presentation occurs when severe pain from a physical trauma or neurotropic viral infection outlasts the expected recovery time, and may subsequently spread to uninjured areas. 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 existing classification was last updated in 2017, when a number of rarer forms of EDS were added.
Compartment syndrome is a serious condition. Increased pressure in a body compartment can harm blood flow and tissue function. If not treated quickly, it may cause permanent damage. There are two types: acute and chronic. Acute compartment syndrome can lead to a loss of the affected limb due to tissue death.
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 syndrome that causes chronic widespread pain, accompanied by fatigue, awakening unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and some infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome". Although a protocol using an algometer (algesiometer) for determining central sensitization has been proposed as an objective diagnostic test, fibromyalgia continues to be primarily diagnosed by exclusion despite the high possibility of misdiagnosis.
Post-polio syndrome is a group of latent symptoms of poliomyelitis (polio), occurring in more than 80% of polio infections. The symptoms are caused by the damaging effects of the viral infection on the nervous system and 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 may also occur years after a nonparalytic polio 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.
Tension myositis syndrome (TMS), also known as tension myoneural syndrome or mindbody syndrome, is a name given by John E. Sarno to what he claimed was a condition of psychogenic musculoskeletal and nerve symptoms, most notably back pain. Sarno described TMS in four books, and stated that the condition may be involved in other pain disorders as well. The treatment protocol for TMS includes education, writing about emotional issues, resumption of a normal lifestyle and, for some patients, support meetings and/or psychotherapy.
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.
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 systemic inflammatory disease characterized by pain or stiffness, usually in the neck, shoulders, upper arms, and hips, but which may occur all over the body. Almost all cases occur in people age 50 or older. Pain and stiffness of PMR is worst in the morning and improves throughout the day, but these symptoms frequently persist to some extent throughout the day and into the evening.
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.
Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.
Hypermobility spectrum disorder (HSD), related to earlier diagnoses such as hypermobility syndrome (HMS), and joint hypermobility syndrome (JHS) is a heritable connective tissue disorder that affects joints and ligaments. Different forms and sub-types have been distinguished, but it does not include asymptomatic joint hypermobility, sometimes known as double-jointedness.
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.
Somatic symptom disorder, also known as somatoform disorder or somatization disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.