What’s This Research About?

Research on hypermobility is lacking. At the time of this publication there was not a consensus on how to manage the common symptoms of pain and fatigue in this population, hence the impetus for this paper. The authors suss out possible treatment options for hypermobile people suffering from pain and fatigue.

The authors categorized pain into three types.

  1. Nociceptive pain which stems from tissue damage and/or inflammatory response. Current pain science shows that tissue damage will not always cause pain. You can sense pain from tissue damage but not always. As we’ve probably all experienced with never having sensed the root cause of an enormous bruise on our leg.
  2. Neuropathic pain is pathology to either the peripheral or central nerves which can come from compressed or damaged nerves. They will present with entrapped nerves, disc herniation, or axonal neuropathy.
  3. Dysfunctional pain is a central sensitization where the pain is amplified with little stress to the system and can be poorly localized. Fibromyalgia, headache, and irritable bowel syndrome (IBS) are examples of these.

With hypermobility it can be problematic figuring out which type of pain is occurring at any given time making treatment harder to tackle. In general people with JHS can be described as having a “mixed chronic pain syndrome” that has to be treated with a multi-pronged approach.

The second major symptom they cover is fatigue, which is present in 80-90% of those with this condition. They point out that many individuals with chronic fatigue syndrome (CFS) may actually have JHM. They mention that a subtype of CFS could possibly be created in this case.

TITLE: Management of Pain and Fatigue in the The Joint Hypermobility Syndrome: Principle and Proposal for a Multidisciplinary Approach

ORIGINAL LINK

PUBLICATION: American Journal of Medical Genetics

DATE: 2012

AUTHORS : Marco Castori, Silvia Morlino, Claudia Celletti, Mauro Celli,  Aldo Morrone, Marina Colombi, Filipino Camarota, Paola Grammaticco

Beighton score: A diagnostic scoring system that gives one point each for excess laxity on right and left: elbow, thumb, pinky, and knee. One point is given for forward fold with palms to floor. High score is 9, suggesting a high degree of joint laxity.

Dysautonomia: A malfunction of the autonomic nervous system that creates problems with regulating heart rate, blood pressure, digestion or temperature control.

Ehlers Danlos syndrome (EDS): A collection of heritable connective tissue disorders thought to alter the biology of collagen in the body (the most abundant protein), which can lead to multi-systemic symptoms, such as: hypermobile joints and soft, stretchy skin, easy bruising, easy wounding, poor wound healing and/or atrophic scarring.

Ehlers-Danlos Hypermobility Type (hEDS): 5-7 or higher on Beighton score plus two or more musculoskeletal issues (pain, dislocations, etc.), systemic involvement (as described above) and positive family history.*

Joint Hypermobility (JHM): A condition that affects one or more of the joints goes beyond its normal limits. Can be diagnosed with the Beighton score, and can also include systemic issues (central nervous system fatigue, pain, anxiety, dysautonomia, and abdominal pain). Diagnosis can be difficult because there can be laxity with no systemic issues, or conversely no laxity with systemic issues. There can be a loss of range of motion due to age or physical limitation but they may still have JHM.

Joint hypermobility syndrome (JHS): A disorder of the connective tissue that can result in unstable joints, skin abnormalities, chronic pain, and fatigue. It can also include many other symptoms. The term “hypermobility” includes a an array of sub categories with a wide continuum of symptomatology. The broadest umbrella term is “hypermobility spectrum disorders”. The spectrum ranges from those who are high functioning (with the only symptom being generalized joint hypermobility), to people with so many symptoms they can be debilitated. The latter would most likely be someone diagnosed as Ehlers Danlos syndrome, hypermobility type (hEDS).

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