The dose of exercise therapy varies from patient to patient. Some children can work through the pain on their own once they realize that they are not going to damage their body by using it. Other children can work well with a local physical therapist who will focus on function and desensitization as well as aerobic conditioning and not stop if the child complains of pain. In general, physical therapists are taught to stop when it hurts, which is excellent advice for everything except amplified pain. The amplified musculoskeletal pain team at the Children’s Hospital of Philadelphia is happy to assist your local health care professionals in gaining a better understanding of the principles of these amplified pain programs. More information can be found here.
Additionally, it is important to work with a psychologist to work on coping through the exercises and also address the individual and perhaps family dynamics to help relieve stress. Having pain is stressful in itself and prolonged amplified pain is emotionally distressing. The biochemical response to stress causes vasoconstriction, which can further exacerbate amplified pain symptoms. This is part of why it is very important to identify stressors and learn to better manage stress.
If the above is not effective, a larger dose of physical and occupational therapy with professionals who focus on treating amplified pain as well as working with mental health specialists who have extensive experience with this condition will be required. There is a list of programs in the United States here. A minority of children do not resolve their pain, even with this high dose of therapy.
Specialized programs to treat children with amplified pain have the added benefit of a community of children with whom they can relate. Many of these children feel isolated. Establishing a community to foster wellness can be a boon to both the patients and the team. Additionally the experience of the specialized team can help determine when a child is ready to move on to the second stage of the program (home exercises, counseling, school, and full function).