Treatment for amplified muscle pain to be offered by UCSF Benioff

Treatment for amplified muscle pain to be offered by UCSF Benioff
“Madison” couldn’t figure out what had triggered the dull ache in her right calf that eventually became more acute, spreading to both of her legs, hips and back. It may have been a sports injury, the 13-year-old told me during her initial consultation. Madison had made repeated visits to her pediatrician, the emergency department and an orthopedist. She’d been extensively X-rayed and had undergone an MRI. Meanwhile, the escalating dose of prescribed painkillers caused abdominal side effects and did nothing to abate the pain that left her confined to bed for most of the day. “A year ago, she was an 'A’ student, and a star soccer and lacrosse player,” her mother reported. “And now she hobbles just to get to the bathroom. She’s weak and fatigued and hasn’t shown up for school for weeks.” Madison has amplified musculoskeletal pain syndrome, characterized by pain out of proportion to what is expected and the absence of any visible injury. Over time, this severe pain prevents patients from engaging in their usual activities. AMPS includes diffuse and localized subtypes. Juvenile fibromyalgia is a form of diffuse amplified pain, while complex regional pain syndrome (CRPS), which is associated with swelling, skin discoloration and temperature changes, is a form of localized amplified pain. Among children, it is most prevalent in teen and preteen girls, and we see it a lot in patients like Madison who are highly motivated achievers. By the time patients reach me, they and their families are baffled and frustrated. Autoimmune diseases like lupus and rheumatoid arthritis have been ruled out, and their imaging and blood work may be normal. They may not look sick, and they may appear more comfortable than they should given the severity of their pain. These patients aren’t malingering, but their disorder is poorly understood and requires a treatment approach that runs contrary to what one might expect. In patients with AMPS, nerves send pain signals to the brain for the wrong reasons. With diffuse AMPS, the brain becomes more sensitive to pain signals, and it interprets non-painful signals as painful. In CRPS, repeated stimulation of pain nerves results in pain signals sent to the brain and to vascular nerves that supply blood vessels. In response, vascular nerves cause blood vessels to constrict, leading to lactic acid buildup in a repetitive cycle that constantly ramps up the pain. With both types of AMPS, pain is severe and is not due to tissue damage. Common sense tells us we should rest the part of the body that is hurting, but studies show that this is not effective with AMPS. Instead we teach our patients to push through the pain with exercises that retrain the nerves. Through aerobic conditioning and desensitization, we restore function and relieve pain. Chronic pain is stressful, so our patients benefit from counseling with a therapist or psychologist to learn healthy coping skills. Some children with AMPS are the worriers of the family, but only after the onset of AMPS does their anxiety become a problem. While half of the patients I see do well with outpatient counseling and rehabilitative therapy, a more intensive program is required for those who are more severely disabled. When UCSF Benioff Children’s Hospital San Francisco moves to its new location in Mission Bay in February, we will open the Amplified Pain Rehabilitation Program for these patients. Our team of physicians, physical and occupational therapists, a psychologist, a music therapist and acupuncturists will work one-on-one with patients in a full-day program that will require children to remain in the hospital for three to four weeks. Our rooftop gardens will be used for exercises like push-ups, planking, knee bends and walking. Tools from our new multisensory room — like padded mats, textured objects and balls that change color on touch — will be incorporated into exercise routines. Once our patients have regained function and addressed the stressors in their lives in healthy ways, their AMPS will resolve. While we cannot promise our patients stress-free or pain-free lives, we can teach them the skills to handle their stresses, and thus keep their AMPS in remission. Dr. William Bernal is a pediatric rheumatologist and pain specialist at UCSF Benioff Children’s Hospital San Francisco. He will head the Amplified Pain Rehabilitation Program. Original article and pictures take http://www.sfgate.com/health/article/Treatment-for-amplified-muscle-pain-to-be-offered-5926093.php?cmpid=pinterest-desktop site