Amplified Pain Syndromes In Children: Characteristics of a Single-center Cohort

Background: Among defined amplified pain syndromes chronic regional pain syndrome and fibromyalgia have been recognised. In children they are often less clear-cut than in adults and the terms localized and diffuse idiopathic pain syndrome (LIPS,DIPS) have been adopted. They are characterized by intermittent or persistent musculoskeletal pain without identifiable aetiology accompanied with significant degree of physical and psychosocial dysfunction.

Objective: To analyze clinical features of a cohort of patients diagnosed with amplified pain syndromes over the 2 year period

Methods: Consecutive patients up to 18 years of age diagnosed between March/2015 and February/2017 were recruited. Upon exclusion of organic aetiology LIPS was diagnosed in the presence of 1-2 painful regions with hyperaesthesia and/or autonomic changes while DIPS patients had 3 or more painful areas or widespread pain for longer than 3 months. Following domains were assessed: Pain(VAS 0-100mm), fibromyalgia(≥11/18tender points), skin sensitivity and autonomic changes, physical function(CHAQ, activities of daily living for upper and lower extremities), Beighton scale for hypermobility(≥6/9), muscle strength (CMAS 0-52), psychosocial wellbeing(PedsQL).

Results: Patient characteristics are shown in the Table. Significant degree of pain was reported by all patients. Lower extremities were commonly affected (80% LIPS and 94% of DIPS) with the knee area predominating. Autonomic changes were more frequent in LIPS while hypermobility and fibromyalgia tender points were more prevalent in DIPS patients. Significant disability (e.g. crutches, wheel-chair) was present in 23(72%) patients as reflected by CHAQ scores.

Conclusion: Children and adolescents with amplified pain represent a difficult-to-manage patient subgroup. High level of suspicion and physicians` awareness of these disabling conditions are crucial for their early recognition and complex treatment that combines vigorous physiotherapy with individually-tailored psychological therapies. Prospective follow-up of these patients is a subject of ongoing study.

Supported by CPS JEP