Chronic pain in a patient with Ehlers-Danlos syndrome (hypermobility type): The role of myofascial trigger point injections

Tewari, Saipriya; Madabushi, Rajashree; Agarwal, Anil; Gautam, Sujeet; Khuba, Sandeep

doi:10.1016/j.jbmt.2016.06.017

Cited by 3 publications

(5 citation statements)

References 7 publications

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“…A study conducted by Tewari S et al [11] revealed that chronic widespread musculoskeletal pain is a cardinal symptom in EDS which can be both physically and psychologically disabling.11 Our patient too had chronic arthralgias, myalgias and easy bruisability for quite a long time resulting in frequent hospital visits.…”

Section: Discussionmentioning

confidence: 71%

Radiological Diagnosis of Ehlers- Danlos Syndrome in an Adolescent Girl with Chronic Musculoskeletal Symptoms -- A Case Report

Ehsan¹

2023

JOJCS

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Ehlers-Danlos Syndrome is a very rare, genetically and clinically heterogeneous, heritable disorder characterized by abnormal collagen synthesis. There are at least thirteen subtypes with variable inheritance patterns, majority being autosomal dominant. The cardinal features include joint hypermobility, skin hyperextensibility, and soft connective tissue fragility. Radiologically, hemarthrosis, precocious osteoarthritis, arachnodactyly and kyphoscoliosis are seen involving the skeleton. We present a case of an 18-year-old girl with joint hypermobility, easy bruisability, joint pain and lax skin. She was undiagnosed until her adulthood. Radiological investigations revealed characteristic arachnodactyly, kyphoscoliosis and precocious osteoarthritis which led to her diagnosis of Ehlers Danlos syndrome.

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Section: Discussionmentioning

confidence: 71%

Radiological Diagnosis of Ehlers- Danlos Syndrome in an Adolescent Girl with Chronic Musculoskeletal Symptoms -- A Case Report

Ehsan¹

2023

JOJCS

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“…[ 30 ] Features suggestive of CS include generalized hyperalgesia, low sensory thresholds, and increased wind-up to repeated stimuli. [ 7 ] Fibromyalgia, a widespread musculoskeletal pain syndrome commonly associated with CS, occurs in 42% of adults EDS. [ 1 , 2 ] Our patient had been referred for query CRPS.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 ] It affects men and women of every race and ethnicity but is known to be more common among non-White populations and women. [ 2 , 7 ]…”

Section: Introductionmentioning

confidence: 99%

“…This fundamental defect in collagen affects all organs with the presence of collagen including joints, ligaments, skin, tendons, internal organ walls such as in blood vessels and gastrointestinal tract. [ 1 , 7 ] Defects in the collagen results in weakness and increased elasticity leading to the above characteristics resulting in chronic pain issues. [ 1 , 7 ] Depending upon the EDS type the manifestations and their consequences on individual patients vary.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 , 7 ] Defects in the collagen results in weakness and increased elasticity leading to the above characteristics resulting in chronic pain issues. [ 1 , 7 ] Depending upon the EDS type the manifestations and their consequences on individual patients vary. Major morbidity and death are commonly as a result of arterial rupture.…”

Section: Introductionmentioning

confidence: 99%

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Management of chronic pain in Ehlers–Danlos syndrome

Zhou¹,

Rewari²,

Shanthanna

2018

Medicine

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Rationale:Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Overall, approximately 90% or more EDS patients suffer from chronic pain. There are no existing guidelines to manage chronic pain in EDS patients. In this article, we illustrate 2 case reports of EDS patients with chronic pain and review the relevant literature regarding the pathological considerations and management of chronic pain in EDS.Patient concerns:Our first patient had worsening multiple joint pains despite treatment with medications and a recent diagnosis of EDS-type 3. The second patient had a complicated history including longstanding EDS and multiple previous surgeries. She was referred due to concern about complex regional pain syndrome (CRPS) in her upper extremity.Diagnoses:For the first patient, apart from chronic pain due to her EDS, her history also revealed that she suffered from kinesiophobia. For the second patient, a detailed clinical assessment revealed no signs of CRPS but instead a generalized worsening of EDS symptoms.Interventions:Both patients were evaluated by the multidisciplinary team consisting of a pain physician, nurse, pain psychologist, and a kinesiologist. Their treatment involved optimization of daily medications, participation in pain self-management sessions that included cognitive behavioral therapy, graded exercises, coping, and relaxation strategies.Outcomes:Both patients demonstrated significantly better pain control and achieved overall improvement in daily living.Lessons:EDS is a complex illness with a multitude of symptoms. As in our patients, EDS patients also suffer from panic and anxiety disorders that increase the burden of pain. Apart from optimization of medications, EDS patients are best managed by a multidisciplinary approach that includes pain education and life style changes. The caution that they are resistant to local anesthetics is unwarranted. Appropriate pain interventions in selected patients may have a role to decrease pain intensity.

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Multidisciplinary Chronic Pain Management Strategies in Patients with Ehlers–Danlos Syndromes

Gullapalli¹,

Javed

2022

Pain Manag.

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Ehlers–Danlos syndromes (EDS) are a group of disorders characterized by abnormal connective tissue affecting several organ systems. Patients with the hypermobile type of EDS (hEDS) commonly experience chronic pain which can present as musculoskeletal pain, fibromyalgia, neuropathic pain or abdominal pain. The effective management of chronic pain in hEDS patients is a challenge. This study reviews two cases of chronic pain in hEDS patients and the multimodal treatment regimen used along with peripheral nerve stimulation for shoulder and knee pains, never before reported in hEDS patients. Since hEDS associated chronic pain is multifactorial in origin, treatment requires a multidisciplinary approach which includes physical therapy, psychotherapy, pharmacotherapy and interventional pain procedures such as trigger point injections, peripheral nerve block, radiofrequency ablation and peripheral nerve stimulation.

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Chronic pain in a patient with Ehlers-Danlos syndrome (hypermobility type): The role of myofascial trigger point injections

Cited by 3 publications

References 7 publications

Radiological Diagnosis of Ehlers- Danlos Syndrome in an Adolescent Girl with Chronic Musculoskeletal Symptoms -- A Case Report

Radiological Diagnosis of Ehlers- Danlos Syndrome in an Adolescent Girl with Chronic Musculoskeletal Symptoms -- A Case Report

Management of chronic pain in Ehlers–Danlos syndrome

Multidisciplinary Chronic Pain Management Strategies in Patients with Ehlers–Danlos Syndromes

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