Arthralgia means “joint pain,” and hypermobility means “unusual and abnormal movements of joints.” So, hypermobility arthralgia refers to a joint pain associated with hypermobility.
Generally, Joint hypermobility syndrome, commonly known as JHS or Ehlers-Danlos syndrome hypermobility type widely known as EDS-HT, is the most common cause of hypermobility arthralgia. These syndromes are underdiagnosed genetically associated connective tissue disorders characterized by extensive joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive issues.
Pain Associated with Hypermobility
The development of chronic pain, as opposed to the acute pain associated with critical injuries, is a common and severe complication of hypermobility, with often disabling physical and psychological consequences. Back pain and myalgia are common symptoms in children with hypermobility, with more than 85 percent of individuals older than 42 years experiencing comparable symptoms. A progressive decrease in the Beighton score is responsible for this evolution, which, by the time the subjects reach the age of 32, tends to fall under a Beighton score of 5 even in the most severely ill issues.
There have been several types of pain described as being more prevalent. For example, nociceptive pain that manifests itself in or around joints may be caused by soft tissue injuries or fascial spasms, which are both common causes. It is generally associated with acute arthralgias that affect the shoulders, knees, and hands in the most extreme cases.
Foot pain is also prevalent, and a combination of joint dysfunctions most likely causes it. Fascial pain or jaw pain is common and could be a contributing factor to temporomandibular dysfunction. Back pain may be due to various factors, including palpable tightness with point tenderness (like that found in fibromyalgia), especially in the paravertebral muscle. The difference between fibromyalgia and hEDS is critical since the differentiation will have an impact on treatment approaches. Because their symptoms are so similar, they might be challenging to identify from one another. Fewer than one-third of patients complain of headaches, with migraines being the most common type reported.
When a patient suffers from persistent daily headaches, hypermobility of the cervical spine may also be a contributing factor, and cervical myofascial pain is common in this population. As a result of the instability at the occipitoatlantoaxial junction in patients with hypermobility, they may present with a Chiari malformation type I.
Osteoarthritis pain can manifest itself earlier in life than in the general population. It is typically characterized by aching/stiff joints, with exacerbations occurring due to prolonged standing and highly repetitive activities. It has also been reported that patients with hypermobility are more likely to develop osteoporosis and osteopenia than the general population. This decreased bone mass may cause fractures to take longer to heal, resulting in pain exacerbation. Neuropathic pain is found in high proportions in patients with hypermobility, with two-thirds of patients exhibiting at least “probable” neuropathic pain at the time of diagnosis. Patients frequently describe the pain as burning, shooting, groggy, electric, or as being intolerable to hot and cold temperatures. There may be a radicular or peripheral nerve distribution present, or the pain may appear to be localized to an area surrounding one or more joints.
A possible explanation is that nerve compression leads to neuropathic pain through the development of subluxations and osteoarthritis. Nerve compression may also occur in the context of myofascial spasm, which is a muscle contraction. MILDER axonal polyneuropathy and compression neuropathies have both been shown to be associated with hypermobility.
In order to develop effective treatment plans, it is critical to distinguish between nociceptive and neuropathic pain. This is especially true because only 11 percent of patients with hypermobility are prescribed neuropathic pain medications, whereas nearly 90 percent take analgesic medications regularly.
Painful sensations can also take on dysfunctional characteristics, manifesting themselves in various ways, including complex regional pain syndrome, fibromyalgia, functional stomach pain, menstrual irregularities, vulvodynia, and sexual dysfunction, to name a few.
Recurrent abdominal pain is widespread, with up to 68 percent of patients experiencing it regularly. Gastroesophageal reflux disease (GERD), gastritis, stomach cramps, and diarrhea are all widespread, as are the associated symptoms.
Pain and hypersensitivity in the hollow viscera may be caused by excessive laxity of the deep viscera, and autonomic nervous system dysfunction may also be a contributing factor to stomach symptoms. The presence of generalized hyperalgesia in adult patients with hypermobility has been demonstrated. Persons with hypermobility may have much lower pressure thresholds than healthy controls, even in parts of their bodies that are not displaying any symptoms.
Central upregulation is hypothesized to occur in the nervous system (CNS), which could lead to the onset of chronicity in some cases. In addition, central sensitization may be the explanation why patients with hypermobility are more susceptible to pain and fatigue than the general population. Hypermobility is associated with decreased lidocaine effectiveness in some patients, which is suggestive of upregulation but can be distressing to the patient. Possibly, central sensitization is a CNS adaptation that is beneficial in preventing undesirable outcomes caused by joint instability (and reduced proprioceptive input in individuals with hypermobility) and may even be helpful in some cases.
Pain Management in Patients With Hypermobility
Like those suffering from other chronic pain syndromes, patients suffering from hypermobility are prone to suffer from considerable psychological and physical disability. The most challenging difficulty for patients with hypermobility is managing their pain and dealing with the physical restrictions that come with it. Improved functional ability, decreased symptomatology, and reduced reliance on the healthcare system and caregivers should be the primary aims of pain management. There is no “magic bullet” or “treatment” for this condition. A combination of nonpharmacological and pharmacological intervention, on the other hand, has the potential to enhance the quality of life significantly. A scarcity of evidence-based studies has resulted in therapy recommendations that are heavily influenced by the clinical judgment of specialists. These patients’ lack of access to an evidence-based approach to pain management shows the lack of attention devoted by health care practitioners to the requirements of this population. Measures such as pain scales and standardized questionnaires (e.g., the International Diagnostic Pain Scale and the Neuropathic Pain Symptom Inventory, the Pittsburgh Sleep Quality Index, and the Central Sensitization Inventory) may be helpful in directing treatment.