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Therapeutic Exercise Eases Pediatric Pain Amplification Syndrome


 

EXPERT ANALYSIS FROM A MEETING SPONSORED BY NEW YORK UNIVERSITY

Upon completion of the exercise program, the children return home to restart their normal activities, including return to school. For children who have been absent from school, Dr. Sherry’s staff works with school staff members to reintegrate the child gradually, sometimes beginning by just having the child spend time in the parking lot or school library. Patients are expected to exercise at home for about 45 minutes a day, and counseling is usually recommended. During this time, pain starts to recede. In the last part of the program, children can stop formal home exercise and hopefully function without pain.

Within the first 1-2 weeks, 80% of patients become fully functional and 95% are fully functional within the first month. After 1 month, 75% are free of pain, according to Dr. Sherry.

Preliminary results are available from an ongoing study in which patients were evaluated for pain and function before the start and after completion of the exercise program, as well as at 1-year follow-up. Preliminary data on 20 subjects showed the mean pain score on a visual analog scale (VAS) before the program was 62.7 out of 100; after the program ended the VAS significantly decreased to 33.9 (P less than .01) and after 1 year, the mean VAS was significantly decreased further to 17.3 (P = .02). Similar trends were seen for fine-motor control, manual coordination, and a total motor composite score. Significant improvements were also seen by the end of the exercise program in body coordination and strength and agility (both P less than .01) but scores remained stable once the program was completed.

Do patients relapse? In an earlier study of 49 patients with an amplified pain syndrome who were followed for 5 years, nearly one-third relapsed (Clin. J. Pain 1999;15:218-23). The median time to relapse was 2 months and 79% relapsed within the first 6 months. "The important thing was that most relapses resolved quickly with 50% of patients able to control their relapse at home by themselves," says Dr. Sherry.

"Within a few weeks, we can get most kids fully functional without drugs or invasive procedures. Kids who won’t put a shoe on, kids who can’t walk, kids on crutches, kids who have been in a wheelchair for 2 years. Within a couple of weeks, we get them to be at least weight bearing."

Dr. Sherry reported having no relevant financial disclosures.

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