Pediatric Pain Recovery

The Root Cause

In a typical pain response, a message is sent from our body to our brain to trigger an alarm that is designed to protect us. The brain responds by sending signals to your muscles to move, telling your blood vessels to constrict, or increasing blood flow to the area in need. 

For example, if you put your hand on a hot stove, your body sends a message to your brain which then sets off an alarm saying “Ouch!! Something needs attention!”

The brain quickly responds by lifting your hand off the stove. At the same time, your brain quickly tells your blood vessels everywhere except your hand to constrict, while sending increased blood flow to your hand that may need attention. 

Once the body removes the painful stimulus and goes through its healing process, the pain signal from the body to the brain stops. The alarm goes quiet, and we no longer experience the pain. 

However, sometimes, the alarm doesn’t go off like it is supposed to. Instead, the alarm changes. 

The technical term for this type of change is called “central sensitization”. Central sensitization is a condition in which the nervous system becomes overactivated and  oversensitive. As a result, it amplifies pain and other sensations, usually long after the original injury or trigger is removed or resolved. 

Central Sensitization may be the root cause of many chronic pain conditions, including AMPS, CRPS, and Juvenile Fibromyalgia. 

Understanding Central Sensitization

If we think of your central nervous system (brain and spinal cord) as a fire alarm. When working typically, a fire alarm will sound an alarm when there’s smoke from an actual fire; a truly painful stimulus. However, sometimes the body’s response or the way that the central nervous system is processing that that initial fire (injury, illness, etc.) can cause the central nervous system to change. 

This change can cause the central nervous system to become over sensitive and overreactive. Now, in this “sensitized” state, the fire alarm may go off when you do not want it to do so, for instance, if you turn on your toaster or light a candle – the alarm is over-sensitive or falsely interpreting the stimuli. Now your body may respond to painful stimuli with a disproportionately large pain response and/or respond to non-painful stimuli as painful. Your nervous system is now acting as an overly sensitive fire alarm, no matter what the stimuli. 

Understanding Our Nervous System 

Our nervous system is designed to learn and adapt, which most times is beneficial to us. However it also can be problematic when repeated pain, stress, injury, illness, or trauma re-train the brain and spinal cord to become over-reactive.

Over time, several things can happen:

• Pain becomes disproportionate to the cause 

• Typically non-painful sensations may begin to hurt or feel painful

• The body becomes more reactive to stress

• Muscles may stay tense and guarded

• Sleep may become disrupted

• Fatigue and brain fog can increase

• The nervous system remains stuck in “fight-or-flight” mode

In simple terms, the volume knob for danger signals gets turned up too high.

Restoring Hope

In the case of central sensitization, the pain that a person is experiencing is “real”, despite the fact that all traditional medical testing and imaging will suggest that “everything looks normal”. This can be an incredibly overwhelming and frustrating situation when your child is experiencing this type of pain. Conditions associated with central sensitization do not show on imaging or lab work because central sensitization involves changes in how the nervous system processes information, not necessarily changes at the site of the initial injury.

The nervous system is adaptable. Just as it can learn sensitivity, it can also learn safety, resilience, and appropriate regulation again over time. And you and your child can learn to restore hope, confidence, and joy in your child’s movement and activity. At Strong Roots PT, we are here to help your child, as well as you and your family, on that journey.

What is Amplified Musculoskeletal Pain Syndrome (AMPS)?

Amplified Musculoskeletal Pain Syndrome (AMPS) is an umbrella term used to describe a group of chronic, non-inflammatory pain conditions in children. These conditions can include juvenile fibromyalgia, complex regional pain syndrome (CRPS), chronic widespread pain, neuropathic pain and other forms of chronic pain. While this pain is very real, it is not caused by ongoing tissue damage. Rather, the pain is best explained by a process called central sensitization. With central sensitization there is a change in how the nervous system processes pain signals. (See further information on central sensitization in section above). 

How do I know if my child has AMPS?

Children with AMPS may experience a wide range of symptoms. Pain can be constant or come and go over time. Children may experience pain in their muscles, joints, bones, or soft tissue and this pain may be localized to one area or more widespread throughout the body. AMPS may begin after an injury, illness, or period of stress, but sometimes it develops without a clear cause.

Some common signs include:

• Persistent or recurring pain lasting longer than 3–6 months

• Pain that does not improve with typical pain medications

• Pain that seems more intense than expected

• Sensitivity to touch (even clothing or light contact may cause pain)

• Changes in skin color, temperature, or swelling (more common in CRPS)

• Difficulty with daily activities due to pain or fear of movement

How can Physical Therapy help with AMPS?

Our physical therapist is educated on specialized AMPS focused treatment that helps re-train the body and nervous system. Treatment takes an active, whole-body approach to restore normal movement, reduce sensitivity, and help your child regain confidence in their body.

Goals of Treatment:

• Help your child return to the activities they love

• Restore strength, endurance, and overall function

• Reduce fear of movement and build confidence

• Improve or resolve pain and related symptoms

• Decrease reliance on medications and medical interventions

• Support independence and long-term success

What is Complex Regional Pain Syndrome (CRPS)?

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that most commonly develops after an injury or trauma such as a fracture, surgery, sprain/strain, burn, cut, casting, nerve injury, etc. CRPS most often affects the arms or legs, though symptoms can sometimes spread to other areas of the body. CRPS can be best explained by a change in the nervous system described as central sensitization (see above for further information on central sensitization). A CRPS diagnosis is often classified into two subtypes, based on symptoms that occur with or without nerve damage. 

How do I know if my child has CRPS?

Symptoms vary from person to person and can also change over time. 

Some common signs include:

• Persistent pain that seems disproportionate to the original injury

• Increased pain in response to painful stimulus and/or pain in response to non-painful stimulus

• Swelling

• Redness

• Temperature differences between limbs

• Changes in skin color or texture

• Excessive or decreased sweating

• Changes in hair or nail growth

• Reduced range of motion or joint stiffness

• Muscle spasms, tremors, or weakness

• Difficulty moving the affected body part

• “Mirror pain” occurring in the opposite limb

How can Physical Therapy help with CRPS?

The primary goal of therapy is to help patients regain function, improve mobility, and reduce pain while preventing further complications.

Treatment focuses on improving range of motion and maintaining joint and muscle flexibility to prevent joint stiffness, muscle tightening, and additional nerve irritation leading to further pain. Gentle, guided strengthening exercises help improve overall function and encourage healthy blood flow to the affected limb, which is essential for recovery and healing.

Treatment may also include a variety of techniques to help manage pain and improve tolerance to movement. This includes desensitization techniques, hot and cold therapy, mirror therapy, TENS, biofeedback, and more. 

Through these treatments patients can regain confidence and safely return to daily activities and focus on being a kid.

What is Juvenile Fibromyalgia? 

Juvenile Fibromyalgia is a chronic pain condition that affects children and adolescents characterized by widespread musculoskeletal pain that typically occurs on both sides of the body. Similar to the conditions of CRPS and AMPS, Juvenile Fibromyalgia may develop after an injury, illness, emotional stress, or other triggering event. In many cases, there is no clear identifiable cause. Fibromyalgia can be best explained by the concept of central sensitization (see above for further information on central sensitization). 

How do I know if my child has Juvenile Fibromyalgia?

Children with Juvenile Fibromyalgia often describe their pain as constant, dull, or aching. Symptoms can vary from child to child and may change over time.

Some common signs include:

• Increased Sensitivity to Pain: Children may experience heightened pain responses to painful stimuli or feel pain from normally non-painful stimuli.

• Fatigue: Children may feel tired even after a full night of sleep.

• Sleep Disturbances: Children may have difficulty falling asleep, staying asleep, or wake up feeling unrested. 

• Frequent Headaches or Migraines

• Irritable Bowel Symptoms: Children may experience abdominal pain, cramping, bloating, or urgent bathroom needs. 

• “Brain Fog”: Children may have trouble concentrating, remembering information, or staying focused.

• Mood Changes: Children may experience signs of irritability, anxiety, or depression. 

• Swelling or Numbness

How can Physical Therapy help with Juvenile Fibromyalgia? 

Specialized physical therapy treatment can help reduce pain sensitivity through desensitization techniques and guided movement in order to restore the connection between the body and nervous system. Treatment also focuses on maintaining or restoring range of motion, strength, and endurance to prevent further complications and pain.

With specialized PT treatment children can: 

• Increase participation in school, sports, and play

• Reduce pain sensitivity

• Improve energy levels and overall function

• Build confidence with movement and activity

With the right support and treatment plan, children with Juvenile Fibromyalgia can successfully return to meaningful activities and focus on being a kid.