Background/Purpose: Management of Amplified Musculoskeletal Pain (AMP) in children (i.e. juvenile primary fibromyalgia, complex regional pain syndrome, neuropathic pain, central sensitization) remains controversial. Common practice includes the combination of potent medications with physical and behavioral therapy.  We hypothesize that functional restoration and pain reduction in patients with AMP does not require potent medications. The objective of this study is to describe a cohort of children with AMP treated with a non-pharmacological highly structured protocol and to test whether previous utilization of pharmacotherapy (as a marker of initial severity) predicts subsequent treatment program outcomes.

Methods: We conducted a retrospective inception cohort study of children with AMP treated with a non-pharmacological multidisciplinary program at The Children’s Hospital ofPhiladelphia between January 2008 and December 2011. All pain medications were discontinued prior to program entry. The primary outcome, function, was measured with the Functional Disability Inventory (FDI) and Bruce Treadmill Score. We tested whether previous utilization of pharmacotherapy predicted treatment outcomes using mixed effects linear regression.

Results: We identified 168 individuals with AMP treated over 4 years. The median age was 14 (IQR: 13, 16 years), and three-quarters of the patients were females. The median pain duration was 18 months (IQR: 9, 36 months) and the median pain score 0-10 at program entry was 7 (IQR: 5, 8). Previous pharmacologic drug therapy exposure included opioids (N=53, 32%), immunosuppressants (N=15, 9%), neurotropics (N=35, 21%), and psychotherapeutics (N=32, 19%).  Median FDI at baseline and program completion were 22 (IQR: 15, 30) and 5 (IQR: 3, 18), respectively.  Median Bruce Treadmill Score at baseline and program completion were 586.5 (IQR: 415.5, 712.5 seconds) and 796 (IQR: 750, 908 seconds), respectively. Median pain score at program completion was 4 (IQR: 0, 7), which is significantly improved from baseline (P=0.01). Change in FDI and Bruce Treadmill Score from start to finish of the program were significantly improved (P<0.001). After adjustment for patient characteristics, there was no significant variation in functional outcomes associated with previous exposure to pharmacotherapy (P=0.43).

Conclusion: These results suggest that in comparison to those children whom were medication naïve and “less severe”, those children with “more severe” disease who were receiving potent pain medications prior to the start of the program were as likely to have restoration of function. Additionally, these results demonstrate that regardless of treatment before program entry, children with AMP have successful restoration of function without pharmacotherapy. Prospective studies are warranted to determine long-term efficacy and effectiveness of this multi-disciplinary program.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multi-modal-amplified-musculoskeletal-pain-treatment-program-associations-of-previous-pharmacotherapy-with-subsequent-outcomes/