When Pain Goes Crazy

He’s had quite the week. Last Saturday he sprained his ankle and then reinjured it Sunday evening. I pulled out our ACE bandage and he mostly stayed off of it, but by Tuesday morning he couldn’t bare weight on it at all. It seemed an odd timeline so I took him along to our chiropractor who is knowledgeable about sports injuries. Suspicious of a fracture he sent us to the hospital for X-rays. Radiology said no fracture so we returned the next day for continued sprain treatment. However, things were worsening instead of getting better and the chiropractor felt suspicious there was a fracture in the growth plate that can’t be seen on Xray.

That afternoon Liam’s pain shot off the charts completely out of control. When I called everyone for dinner and the kids said Liam doesn’t want to eat I went to investigate. He’d hunkered down completely under the blanket so even his head was covered and lay there sobbing. When I unwrapped his ankle, his whole body was spasming and writhing. David carried him to the van and we headed in to see the on call pediatrician who said the same thing. Probably a sprain, possible growth plate fracture, plus and a referral to ortho. The next day ortho listened, tried to touch his leg, noticed the posturing and said, hmm, this looks like amplified pain syndrome.
Her baseline diagnosis after Xray was the same. Sprain, can’t definitively rule out a fracture across the growth plate, and after she saw the photo of his purple leg she added amplified pain syndrome. As she explained the way kids’ nervous systems sometimes go haywire after a minor injury like a sprain, the escalating pain finally began to make sense.

Sometimes, for unexplained reasons, the pain signal short circuits and instead of reaching the brain, it hits the autonomic nervous system where it affects multiple systems causing vasoconstriction to the point of shutting off blood flow to the affected area (the way Liam’s leg would suddenly turn completely purple) which in turn built up lactic acid increasing pain. Because it can’t be processes in the brain, the pain signal continues to escalate and escalate. It also causes extreme skin sensitivity (Liam was so sensitive she couldn’t even evaluate his sprain) and sometimes posturing. She decided to put him in a walking boot, partially because she couldn’t completely rule out a fracture even though it seemed unlikely, but mostly because he was posturing so significantly she said he could end up with contractures.

Thankfully, he’s off crutches and down to just a boot. And thankfully his pain has decreased significantly. He’s back to trying to shoot baskets with one foot, hobbling through hallways with speed, and hoping against hope that he’ll heal enough to go on their annual skiing trip this year.

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