Causes of Amplified Musculoskeletal Pain Syndrome | The Children’s Hospital of Philadelphia
This is post expands upon a previous post: Have Pain? Are You Crazy?. Dr. Sherry has decided that CRPS is actually a mental disorder which he calls amplified musculoskeletal pain syndrome (AMPS). He advocates against treating the pain:
There are three major causes for the abnormal reflex in children with amplified musculoskeletal pain syndrome (AMPS): injury, illness and psychological stress.
Types of injuries that lead to AMPS Injury is the cause of AMPS in approximately 10 to 20 percent of children.
llness is an infrequent cause of amplified musculoskeletal pain syndrome. It is most commonly seen in conjunction with four inflammatory illnesses of the musculoskeletal system: arthritis, tendonitis, myositis or enthesitis. Other illnesses may be the initial cause of pain; most are infections such as mononucleosis, influenza or gastroenteritis. Constipation can also lead to amplified abdominal pain.
In at least 80 percent of children with amplified musculoskeletal pain syndrome, psychological factors seem to play a role
One major stressor we see in many children is the psychological consequence of having such severe pain. This frequently is due to others not understanding the nature of the pain (many friends, teachers and family members do not believe the pain is as intense as it is) and also having a delay in diagnosis and multiple failed therapies
Dr. Sherry seems to contradict himself repeatedly:
One major stressor we see in many children is the psychological consequence of having such severe pain. This frequently is due to others not understanding the nature of the pain.
— versus another of his statements —
The pain is very real and very intense. Even in those children for whom psychological stress is a trigger or complicating factor, the decreased blood flow to the area of AMPS causes extreme body pain.
The reasoning seems to be that pain is what’s causing the “conversion” symptoms, so why not just treat the pain?
Is AMPS all in my child’s head? No, not at all. The pain is very real and very intense. Even in those children for whom psychological stress is a trigger or complicating factor, the decreased blood flow to the area of AMPS causes extreme body pain.
Conversion symptoms occur when the subconscious emotional self causes nerve activity or inactivity. The classic example is a child who suddenly goes blind after seeing her dog get run over by a car.
It is easy to theorize about the subconscious, but making such statements as though they were proven facts is unscientific and misleading.
Conversion symptoms we commonly see include:
- Involuntary spasms of the muscles, such as a clenched fist or shaking (sometimes mistakenly called dystonia)
- Dizziness, Racing heart Fainting and lightheadedness, often called postural orthostatic tachycardia syndrome (POTS) or dysautonomia
- Non-epileptic events (or pseudo seizures)
- Shortness of breath Memory problems
- Paralysis
- Numbness
- Coughing
- Urinary urgency or retention
- Inability to talk and visual difficulties (for example, unable to read but can see).
Some of these symptoms are evidence of a serious illness, like POTS. There is no scientific debate about this being a physical malfunction of the body, so Dr. Sherry is simply wrong.
EDS and Chronic Pain News & Info 
Just read this and the comments that were said about Dr. Sherry have not been completely explained. Dr. Sherry does not believe in treating the pain because to treat the syndrome the nervous system needs to be retrained. In order to do this the body should be off of medication. Besides there is no medication that really helps that type of pain.
Dr. Sherry also believes from treating patients for many years is that psychological stress can make pain worse not that it actually causes it. My daughter was treated by Dr. Sherry and have seen his theories and treatments work.
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There’s no doubt that the success of some therapies are due to the placebo effect — which is not fake, but an amazing reaction by our brains, triggered not by the therapy, but by neuroplasticity and in the strength we can find within ourselves.
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Whoever wrote this article clearly has no idea what they’re talking about. Sorry to say but I’ve been through all of this personally and went through dr Sherry’s program and I have conversion disorder along with EDS along with AMPS. You clearly don’t really fully understand AMPS so please don’t write about it.
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I could certainly be wrong about this. Could you send me links to authoritative articles on this syndrome so that I can better educate myself and my readers?
Thank you for pointing this out!
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my daughter has hEDS and was just diagnosed with AMPS/Fibro i also have both hEDS&fibro. i am desperatly searching for things to help with my 10 year old.
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You could try seeing Dr. Sherry yourself.
Readers have complained that it’s a legitimate diagnosis and treatment, but when I ask for more info I only get silence, and that doesn’t give me much confidence in this “treatment”.
However, we are all so different it might be just what you’re looking for.
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Who is writing this BS. Dr Sherry’s comments do not contradict, you just don’t understand and have no knowledge of what you are talking about. I know first hand of the syndrome as well as many other patients that have been treated for AMPS. There is an overlap of symptoms to other illnesses and correct diagnosis is important
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Yes, I do not understand because I’m approaching it from the opposite side: my chronic pain was routinely dismissed until I was finally diagnosed with EDS, which definitely causes physical, nociceptive pain. Too often, pain patients are told they don’t really have a physical problem just because the doctors don’t know what it is yet, so this seemed like just another such dismissal.
Could you send me links to authoritative articles on this syndrome so that I can better educate myself and my readers?
Thank you for pointing this out!
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Here are just a few studies that should help you understand ALL of Dr. Sherry’s theory and protocols. Admittedly, there are simpler versions out there, but you seem to want journal-presented data, so here you go. But please inform yourself before you direct people away from his program which changed my life (see my website at http://www.ampspain.com for simpler, anecdotal information).
While the psychological stress I was experiencing was one factor Dr. Sherry taught me to manage, you are neglecting to acknowledge his focus on the very real, physical pain I was experiencing. In fact, several doctors at other very notable hospitals (all of whom misdiagnosed me and all of whom medicated me with everything from ketamine to steroids to neurontin) did try to suggest to my family that my pain was in my head, or that I was making it up. Dr. Sherry was the first doctor I saw in the course of 2.5 years who actually believed me, carte blanche, when I expressed my level of pain. Many doctors tried to say my pain was invented or overblown by my emotional state; only Dr. Sherry was willing to recognize that the pain was CAUSING my psychological stress. He flat-out asked me at my intake appointment if doctors had accused me of inventing my pain and, when I articulated my experiences, he told me that the most important thing I needed to understand was that my pain was VERY real and had to be treated both at its source (in my brain) and in the limb where it was inappropriately manifesting itself (in my right leg…which I couldn’t even walk on and had to be brought to his hospital in a wheelchair).
He treated my emotional state and my physical state. It was rough work, re-sensitizing my nervous system, but it worked. I respect your frustration and your pain. But the CHOP program is life-changing and no one should avoid seeking treatment because one person failed to do accurate research.
The first study is Dr. Sherry’s own work and the other three will help you understand the critical role of physical therapy and nerve re-training, the concept of neuroplasticity, and the idea that pain is actually a brain manifestation — ALL PAIN is processed in the brain. Understanding that biological reality is very important. But recognizing pain as a brain function and saying it’s “all in a patient’s head” are two very, very different things. And the latter is absolutely NOT Dr. Sherry’s belief whatsoever. Please do not misrepresent him.
https://www.ncbi.nlm.nih.gov/pubmed/10782856https://journals.lww.com/pedpt/fulltext/2005/01710/a_treatment_approach_to_chronic_amplified.35.aspx
https://my.clevelandclinic.org/health/diseases/17933-amplified-musculoskeletal-pain-syndrome-amps-in-children
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922795/
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Thanks for the links – and I’m glad to hear a success story from his treatment because I’ve only heard horror stories from other pain patients.
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I read the PMC article, and I see that it’s dealing with a certain kind of chronic pain that not all of us have. They are talking about a different beast than the pain that comes from EDS, sickle cell, arthritis or other syndromes like them.
Due to my genetic flaw in collagen production, all my connective tissue is defective. From this condition, we suffer a continuous series of micro-injuries because we are literally not “held together” correctly. Pushing our bodies harder makes them tear apart and break down instead of building them up – that’s the extremely painful lesson I had to learn as an athlete.
I don’t have typical chronic pain, because EDS is actually a collection of acute pains from countless internal injuries that arise from normal activity. My pain pops up all over my body, usually in joints most of us aren’t even aware of, like displacement of the sacroiliac joint or where ribs meet the sternum. Even internal organs are displaced when the connective tissue falls apart. These are “chronic injuries” more than chronic pain.
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Why would you say he is wrong. I have AMPS and know first hand that what doctor Sherry says is completely true.
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Perhaps I’m sensitive about this diagnosis because I was suspected to have it, when my correct diagnosis is Ehlers-Danlos Syndrome. I resent my pain being dismissed as arising from my mind, when in my case, it’s simply a mechano-biological issue of defective connective tissue.
Yours is the 2nd comment claiming benefit, so this treatment must be effective for some of the people showing these symptoms. Again, I’m amazed how different our bodies are and how individualized treatment is the only rational approach.
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Unfortunately, your understanding of Dr. Sherry’s CHOP team’s extensive research and success seems extremely limited. He does not, in fact, as you have grossly understated, believe that AMPS is a “mental disorder” and to categorize it (or CRPS, as you seem to have inextricably linked the two) is uninformed and misleading. Read more than one article before attempting to discredit an entire body of research whose extensive program has helped thousands of children overcome a debilitating disorder.
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Could you please give me some links where I can learn more about it? They would have to be science articles not authored or influenced by Dr. Sherry himself.
I’ve only heard stories from folks who were forced to suffer because they were misdiagnosed, especially with an invisible condition like EDS.
Having so much life-long inexplicable pain, I’m very sensitive to official pronouncements that my pain is not a physical limitation. I was an endurance competition athlete before my pain overcame all my efforts to “tough it out” and override it. I pushed myself so hard that I was in tears during these events and considered suicide as I gradually lost the ability to participate in the activities I loved most in life. I doubt Dr. Sherry could push me any harder than I did myself for years on end.
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Interesting about EDS and pain because I have a friend with EDS hypermobile and also has RSD. I have heard of other EDS patients with amplified pain disorders. Your pain is not in your head and it is real! I have a daughter who went through Dr Sherry’s program with success while later discovering she was suffering from Lyme disease and I also have another daughter who is confirming an EDS diagnosis from a geneticist. The geneticist said it is not unusual for patients to have connective tissue problems and neurological issue, chronic pain, migraines etc. Dr Sherry’s program uses intense exercise and occupational therapy to retrain the nervous system. If a pain program was geared to an EDS patient maybe the same results can be accomplished? Wish it was a simple solution for your pain. Hope you can find some resolution soon.
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I have some specific questions about the program:
1) how are children protected from, god forbid, an abusive staff member, if they are forced to sleep alone in a room without any way to contact the outside world?
2) Same question about not being able to use a phone to speak to anyone privately.
3) Same question about guardianship being handed to the facility. Couldn’t children be threatened with never going home? Couldn’t the threat come true?
4) Why is “asthma” in scare quotes in some of the promotional materials?
I find myself worried about these kids.
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