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March 8, 2021

Amplified Pain Syndrome—An Insupportable Assumption

Author Affiliations
  • 1Spinal Research Laboratory, Stanley Steyer School of Health Professions, Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 2Arthritis and Osteoporosis Foundation of Western Australia, Shenton Park, Western Australia, Australia
JAMA Pediatr. 2021;175(6):557-558. doi:10.1001/jamapediatrics.2021.0111

Amplified pain syndrome (APS) is a diagnostic label used to encompass a broad spectrum of chronic, idiopathic pain conditions that can affect children. They include fibromyalgia, complex regional pain syndrome, headaches, diffuse widespread musculoskeletal pain, and functional stomach pain.1 The common theme uniting this hypothetical spectrum is said to be “central and/or peripheral sensory pain amplification.”1(p2) Currently, there is no agreement as to causative mechanism, pathogenesis, or even the criteria used for the diagnosis of these conditions.1 Notwithstanding these major nosological and epistemological deficiencies, APS seems to have been accepted into the taxonomy of pediatric pain medicine.1 In this Viewpoint, our aim is to show that APS is a flawed construct that has the potential to stigmatize children presenting with severe and disabling pain.

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    1 Comment for this article
    Medically Unexplained Symptoms
    Robert Smith, MD | University Distinguished Professor of Medicine and Psychiatry Emeritus Michigan State University
    See my recent Commentary supporting your findings: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768562

    These diagnoses in the broad category of medically unexplained symptoms, of which Amplified Pain Syndrome is a prominent example, are not validated and have gotten a life of their own.

    When the pain syndrome (or other physical symptom without an explanation) is disabling and associated with frequent visits, we should understand the pain as a symptom suggesting underlying depression and/or anxiety.