Chronic pain in hypermobility syndrome and Ehlers–Danlos syndrome (hypermobility type): it is a challenge – J Pain Res. 2015 – Free full text
Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain.
When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed.
In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers–Danlos syndrome.
However, within the Ehlers–Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers–Danlos syndrome hypermobility type (EDS-HT).
Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2).
In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3).
Despite recent scientific advances, many obstacles for clinical care and research still remain.
To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available.
Future research and clinical care should
revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1),
account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and
create a clinical core set (Solution 3).
HMS and EDS-HT are multifactorial diseases that affect all levels of human functioning.
Dysfunction can be the result of chronic pain but also due to
- multisystemic involvement,
- psychological distress, and
- related disability.
Notice how different it sounds when you reorder those as:
- multisystemic involvement,
- related disability, and
- psychological distress.
Now it’s clear that the psychological distress is due to the disability, not the other way around.
This deception is the same method being used to find that:
Opioid use leads to ” psychological distress, and related disability.”
While this is true, it ignores the underlying cause of the opioid use, which is pain.
So many of the recent headlines and studies blame “opioid use” for all kinds of problems and completely ignore that the level of opioid use is determined by the amount of pain a person is having.
How chronic pain and multi-systemic deficits come into effect and interact with each other is currently unknown.
## Yet this doesn’t stop them from insisting that it’s opioid use that’s causing probelms instead of the underlkying pain.
The specific problems associated with the GJH-related syndromes, as compared to other chronic pain syndromes, are still challenging for most physicians and other health personnel due to many issues surrounding etiology, disease classification, diagnostics, and treatment.
To develop new innovative ways of treating chronic pain, interdisciplinary cooperation should be stimulated and issues concerning clinical heterogeneity, disease classification, and diagnostics should be addressed. In addition, lessons learned from other fields of chronic pain management should be considered.