Jonathan Aarons M.D.

Tired of Chronic Pain?

Pain with Hypermobility Disorders

Pain with hypermobility disorders is a widely overlooked condition. Hypermobility disorders may be associated with a wide variety of chronic pain issues. These disorders include such entities as Erhlers-Danlos Syndrome (EDS) and other disorders of connective tissue. Joint hypermobility may occur in up to 2% of the general population and occurs more often in females, dancers, gymnasts and musicians. Patients may have widespread joint pain as well as extra-articular manifestations. Joint hypermobility may be identified using the Beighton score of 0-9, which is the only validated scoring system.

Additionally, patients with hypermobility disorders are at risk for recurrent injuries with minor trauma. These include dislocations, subluxations, tendon and ligamentous injuries and bursitis. Chronic pain with hypermobility disorders can occur in up to 30% of children and 80% of adults.

The chronic pain from hypermobility disorders can including joint aches (arthralgia) and muscular or myofascial pain. Back pain and headaches can occur. Osteoarthritis and osteoporosis occur more frequently than in the general population. Unusual painful conditions can develop such as CRPS, fibromyalgia, abdominal pain and neuropathic pain.

Other manifestations of hypermobility disorder including hyperelasticity of skin, easy brusing, cardiac autonomic dysfunction, chest pain, chronic fatigue, cognitive dysfunction and sleep disturbance. Anxiety among these patients can worsen the problem, leading to disability and depression.

Finally, pain management with chronic hypermobility disorders is multi-faceted. Pharmacologic therapy should be used along with physical therapy and psychological modalities. The baseline treatment includes acetaminophen and non-steroidal anti-inflammatory medications. Steroids should be avoided for chronic treatment. Anticonvulsants such as gabapentin and pregabalin can be tried. Skleltal muscle relaxants can treat the myofascial components. Anti-depressants can be used to treat the neuropathic pain. Opioids should be administered only after the above methods have failed. The risk of tolerance and substance abuse are significant. Cannabinoids are another option for treatment as well.

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