Diffuse amplified musculoskeletal pain syndrome in children and adolescents

Diffuse amplified musculoskeletal pain syndrome (AMPS) is also known as paediatric fibromyalgia and is typically seen in adolescents. It is characterised by generalised pain that is not specifically articular, does not exhibit the diurnal variation typical of inflammatory joint disease, and may be associated with excessive fatigue. Features may overlap with chronic fatigue syndrome. Physical examination is normal, with the exception of multiple nonarticular tender points.

Initial management of diffuse AMPS involves a detailed explanation of the diagnosis and reassurance that serious pathology has been excluded. Other important aspects of management include:

• reducing school absence because school attendance is frequently impacted—see Suggested features of a school attendance plan for a child with chronic pain
• good sleep hygiene—see the Raising Children website for advice
• exercise
• support for the adolescent as they resume their regular routine.

Cognitive behavioural therapy (CBT) and pharmacological therapy may benefit some patients.