Amplified musculoskeletal pain syndrome (AMPS) is a feeling of acute or chronic pain which has no apparent cause or reason. With such a definition it is clear that the examples, possible causes, symptoms and treatment options can vary greatly and cover a wide variety of medical fields. In this article we will try and clarify some of the most common misconceptions and present some possible solutions.
What is AMPS?
AMPS stands for amplified musculoskeletal pain syndrome which, as its name suggests, is a pain that can occur all over the body and which is usually more intense than it could be expected. Similarly, its cause is often non-existent or unknown, although there are some instances when pain has a source but it greatly surpasses the severity that could be expected.
The pain can present itself anywhere in the body, affect the entire body or a certain area and it can be constant or appear at times with or without any particular schedule or order.
In order to understand why the pain experienced is excessive, we first need to observe how the normal pain mechanism works and then address the differences.
When some kind of a pain source occurs (tissue damage, for example) the pain nerve is activated and it sends the information to the spinal cord. The spinal cord sends the information to the brain where the information is understood as pain sensation. The location, type and intensity of pain depend on the information which the brain receives. In order to understand AMPS better it is important to note that the same information that goes to the brain from the spinal cord also goes to the neurovascular nerves. These nerves control the way blood vessels work and they are very important for the feeling of pain because they make the vessels constrict and thus reduce the amount of oxygen that the muscles get, which leads to an increase in acids which, at long last, increase pain.
What creates the greatly intensified feeling of pain for the amplified musculoskeletal pain syndrome is an unusual occurrence within the spinal cord. It is a kind of a short circuit in the spinal cord. When the information goes to the short circuit it intensifies the reduction in blood flow and increases the feeling of pain beyond the regular levels.
This pain can have several different forms. It can be present all over the body, in certain regions and completely localized. It can also be chronic, or intermittent and it can come with no changes in colour, form or temperature which is why people often look completely healthy even though they are experiencing severe pain.
Definition of amplified musculoskeletal pain syndrome
As one can assume from everything previously mentioned, clearly defining amplified musculoskeletal pain syndrome is far from easy. It gets even more difficult to do so when we have in mind that many causes of pain can seem less than obvious at first, so a misdiagnosis can often occur.
A commonly accepted definition of amplified musculoskeletal pain syndrome (AMPS) is that it is a medical condition in which a patient experiences abnormally intensive pain due to an anomalous pain reflex. This reflex causes overconstriction of blood vessels and reduces the amount of oxygen for the muscles and bones which allows acids to build up. This increase in the acids concentration causes the pain signal to be amplified.
Amplified musculoskeletal pain syndrome itself is not a disease. It is a condition in which the pain threshold is too low, so mild sensations can cause pain.
However, it is often associated with other medical conditions such as complex regional pain syndrome, fibromyalgia, myofascial pain syndrome, allodynia, different kinds of neuropathic pain, psychogenic pain, reflex neurovascular dystrophy and more.
Causes of amplified musculoskeletal pain syndrome
There are three distinct causes of amplified musculoskeletal pain syndrome and these include stress, physical injury and illness. However, there can be more of them, including aging-related causes, hormonal changes or genetics. Amplified musculoskeletal pain syndrome rarely comes from one of these sources, but it is more often a combination that leads to the most severe cases.
Many of the children with amplified musculoskeletal pain syndrome have joint flexibility issues, also known by the name ‘growing pains’.
As mentioned, stress and other psychological factors such as emotional trauma can also cause amplified musculoskeletal pain syndrome. However, this is difficult to determine beyond doubt since amplified pain inevitably causes stress, sleeping difficulties and general disruption in regular daily activities. Stress is a common occurrence with amplified musculoskeletal pain syndrome, but it is not always clear if it is the cause, or the result.
Amplified pain syndrome in children
Children are most commonly most affected by amplified musculoskeletal pain syndrome and it is significantly geared towards females. 80% of patients are pre-adolescent to adolescent girls. This adds another issue for the patients since children are often accused of lying about the pain they feel especially when there is no visible cause of physical change.
The pain can also prevent proper physical development since oversensitivity reduces their participation in various group activities and rules out most sports.
Children often suffer from joint flexibility and allodynia and the severe changes in their development years can severely increase pain sensation.
Amplified musculoskeletal pain syndrome treatment
There are several different forms of treatment. Therapeutic exercises are necessary to make the nerves work as they should. They are often a problem since many patients feel severe pain and are reluctant to exercise.
In spite of this, many experts recommend intense exercise for several hours a day as they have shown to provide very good results. In fact, it is the only way that guarantees significant improvement for a majority of patients.
Restoring function is a part of the treatment which requires the widest approach, usually including a number of experts such as physician, physical therapist and even a mental health professional.
In recent years many patients have turned to pain management that allows them to exercise and also makes their daily routines easier. This relief comes from very powerful pharmaceutical grade palmitoylethanolamide (PEA) products.
PEA is very effective against different kinds of pain and inflammation and its effects come through nuclear receptors, including the ones within the body’s natural endocannabinoid system. Many of these receptors regulate the feeling of pain, but they also positively affect cells and help them restore their internal balance.
Speaking of the pain relieving properties, relieving inflammation is already a good start, but PEA also inhibits COX-2 and iNOS and reduces the influx of neutrophils. This makes pain significantly less intensive and allows patients to be more active and deal with amplified musculoskeletal pain syndrome through exercise.
The biggest advantage of PEA is not just its pain relieving function. There are other pain relieving options, but drugs like NSAIDs and opioids come with bad side effects.
PEA is an endogenous fatty acid which has not a single side effect. Moreover, it can be used with any drug without any contraindications and it causes no habituation problems. It has no downsides and its pain and inflammation relieving benefits have been documented in more than 400 medical studies so far. PEA could be a breakthrough solution that enables AMPS patients to increase the intensity of exercising beyond the levels deemed possible at the moment.