Pain and fatigue in EDS-JHS – Part 3: Fatigue

This is the third part of a 4-part series from an annotated PubMed free full text article:

Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers–Danlos syndrome, hypermobility type): Principles and proposal for a multidisciplinary approach – Castori – 2012 – American Journal of Medical Genetics Part A – Wiley Online


Chronic fatigue is a persistent overwhelming sense of tiredness, lack of energy, and feeling of exhaustion

Such a mixture of unpleasant perceptions is nearly universal in adults with JHS/EDS-HT.

Manifestations of fatigue-related features in JHS/EDS-HT are wide and overlap criteria for the chronic fatigue syndrome (CFS) in more than 80% of the patients

The correlation between JHM and CFS was explored by various research groups, which inconstantly demonstrate a unexpected higher rate of generalized JHM in patients with CFS.

It is possible that JHS/EDS-HT really affects a significant number of CFS patients with primary musculoskeletal dysfunction and a lower rate of symptoms related to impairment of the immune system (e.g., tender lymph nodes and sore throat). This anticipates etiological heterogeneity for CFS and the possible role for JHM in characterizing a specific subtype of CFS

The cause(s) of fatigue in JHS/EDS-HT is(are) debated

five major determinants of fatigue are delineated, namely

  1. sleep disturbances,
  2. concentration problems,
  3. social functioning,
  4. self-efficacy concerning fatigue, and
  5. pain

Besides concentration problems, which are likely a result of chronic fatigue, all the remaining are possible causes for fatigue combining together in different ways case by case

Furthermore, muscle weakness has been recently outlined as a contributing factor to fatigue in EDS, maybe in term of post-exertional malaise.

On a pathogenic perspective, additional systemic characteristics of JHS/EDS-HT can be involved in generating a persistent feeling of exhaustion. In particular, the link between JHM and dysautonomia is a relatively consolidated concept

In addition, an increased rate of celiac disease was demonstrated in JHS/EDS-HT and this evidence may indicate intestinal malabsoption as a possible trigger for fatigue, at least in a subset of patients

an increased rate of asthmatic symptoms and atopy associated with increased lung volumes, impaired gas exchange, and an increased tendency of both the lower and upper airways to collapse in JHS/EDS-HT.


In light of the recent findings, various disease characteristics may be identified as contributors to fatigue in JHS/EDS-HT (Table II. Contributing Factors to Fatigue).

Outline of this series of posts:

  1. Pain and fatigue in EDS-JHS – Part I: Intro and Quality of Life
  2. Pain and fatigue in EDS-JHS – Part 2: Pain
  3. Pain and fatigue in EDS-JHS – Part 3: Fatigue
  4. Pain and fatigue in EDS-JHS – Part 4: Tables and Conclusion

1 thought on “Pain and fatigue in EDS-JHS – Part 3: Fatigue

  1. Pingback: Management of chronic pain in EDS – part 2 | EDS and Chronic Pain News & Info

Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.