A recent review (Curr Opin Rheumatol 2014; 23: 1-12 -thanks to our pain team for sending reference) makes a number of important points regarding the pathogenesis and management of amplified pain syndromes (APS).
Table 1 lists the diagnosis and pain presentations. These include complex regional pain syndromes, juvenile fibromyalgia, diffuse idiopathic pain, concomitant conditions (including irritable bowel syndrome, chronic fatigue syndrome, interstitial cystitis, chronic headache, functional abdominal pain, and conversion symptoms/disorder).
- Pediatric APS are widespread and under-recognized
- Pathophysiology is complex with numerous contributors “including central sensitization, abnormal cytokine production, sympathetic-sensory disorders, autoimmune responses, altered blood flow, genetic predisposition, and psychosocial factors.”
- “The clinical effectiveness of medication management in pediatric APS remains unclear and controversial.” It is noted that preoperative gabapentin and pregabalin may reduce the incidence of chronic post surgical pain (in adults); this has not been documented in a pediatric population.
- “Exercise-based and cognitive-based treatments remain the cornerstone of therapy.” Intensive multidisciplinary pain rehabilitation “restores functioning rapidly, reduces pain in the long run, improves comorbid psychological distress, and reduces medical utilization.”
- Potential elements of treatment noted in Table 2 (geared more towards rheumatology), including exercise, desensitization, self-regulation (eg. diaphragmatic breathing, guided imagery), and stress management/counseling.
Bottomline: For children with severe pain symptoms, multidisciplinary pain teams can be very helpful. However, there is not a simple pill that will fix everything.
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