title: Amplified pain syndromes in children: treatment and new insights into disease pathogenesis.
abstract: OBJECTIVE
  Although many diagnostic terms are used for pediatric chronic pain, evidence suggests a common thread of signal amplification, leading to the unifying term 'amplified pain syndromes'. Ongoing research provides new insights into biopsychosocial contributors and treatments for pediatric amplified pain syndromes.
  
  
  RESULTS
  Basic science indicates a complex interplay of genetic, epigenetic, neurochemical, endocrine, and inflammatory contributors, along with environmental and psychological factors. Although medications and interventions remain common approaches to children with chronic pain, their evidence is limited. Preliminary evidence exists for mindfulness-based therapies, yoga, and other complementary/alternative medicine approaches. The strongest evidence is for exercise-based and cognitive-behavioral treatments, in particular, when combined in a multidisciplinary format. Intensive approaches (pain rehabilitation) have the potential to effectively and efficiently treat those most disabled by amplified pain syndromes, and lead to sustained improvement in pain, functioning, and medical utilization.
  
  
  CONCLUSIONS
  Although understanding of the mechanisms underlying pediatric amplified pain syndromes evolves, standard of care is multidisciplinary emphasizing exercise therapy, cognitive-behavioral treatment, and self-regulation. Treatment should target full return to physical function, which leads to subsequent improvement or resolution of pain. Multidisciplinary care can be coordinated by a rheumatologist or other physician with appropriate referrals, or through a multidisciplinary team.
authors.affiliation: aRehabilitation for Amplified Pain Syndromes program, Children's Mercy Hospital bUniversity of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
authors.forename: Cara M
authors.initials: CM
authors.lastname: Hoffart
authors.forename: Dustin P
authors.initials: DP
authors.lastname: Wallace
mesh_terms: D002648:Child; D059350:Chronic Pain / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D000529:Complementary Therapies; D016207:Cytokines / Q000502:physiology; D044127:Epigenesis, Genetic; D005081:Exercise Therapy; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology; D009490:Neurosecretory Systems / Q000503:physiopathology; D018377:Neurotransmitter Agents / Q000502:physiology; D059408:Pain Management; D017288:Pain Threshold / Q000502:physiology; D054969:Primary Dysautonomias / Q000503:physiopathology; D011584:Psychology; D013577:Syndrome
chemical_list: D016207:Cytokines; D018377:Neurotransmitter Agents