Multimodal Chiropractic Care for Pain and Disability in a Patient Diagnosed With Ehlers-Danlos Syndrome-Hypermobility Type: A Case Report

Strunk, Richard G.

doi:10.1016/j.jcm.2016.12.002

Cited by 4 publications

(5 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Within the multidisciplinary team, physical therapy plays a central role in management of individuals with EDS. [ 1 , 2 , 5 , 10 , 26 , 27 , 34 ] However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management of EDS. [ 27 ] The main objective of rehabilitation is to reduce disability and to improve quality of life.…”

Section: Discussionmentioning

confidence: 99%

Management of chronic pain in Ehlers–Danlos syndrome

Zhou¹,

Rewari²,

Shanthanna

2018

Medicine

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Management of chronic pain in Ehlers–Danlos syndrome

Zhou¹,

Rewari²,

Shanthanna

2018

Medicine

View full text Add to dashboard Cite

show abstract

“…Thrust manipulation to adjacent spinal segments has been safely performed in those with single and multilevel spinal fusion [ 16 , 17 ]. Evidence regarding the safety and efficacy of joint manipulation for those with EDS is scarce; however, case reports have demonstrated the safe application of low-amplitude joint manipulation as part of a multi-modal plan of care with no reported adverse effects in individuals with EDS [ 18 ].…”

Section: Case Presentationmentioning

confidence: 99%

Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report

Mayo¹,

Keating²

2023

Cureus

View full text Add to dashboard Cite

This case describes the clinical decision-making behind the conservative clinical management of an individual presenting with chronic neck pain with myriad neuromuscular comorbidities. The focus of this case report is to support the safe utilization of manual therapy and describe the tolerable prescription of strength and endurance exercise in a patient with numerous complications to improve self-efficacy. A 22year-old female college student presented with a chief complaint of chronic, non-specific neck pain with comorbid Chiari malformation, migraines, upper cervical spinal fusion, Ehlers-Danlos syndrome (EDS), and postural orthostatic tachycardia syndrome (POTS) to an outpatient physical therapy clinic for evaluation and treatment. Following four sessions of physical therapy treatment, no clinically significant improvement in the individual's symptoms and daily function was achieved. Despite the lack of measurable change, the patient reported the program's value on her ability to self-manage her complex condition. The patient responded well to manual therapy, specifically thrust manipulations. In addition, both endurance and strengthening exercises were well tolerated and provided a measure of self-management that may not have been achieved before physical therapy management. This case report highlights the need for exercise and pain-modulating interventions in highly complex individuals to reduce medical intervention by advancing the patient's self-efficacy. There is a need for further research about the utility of standardized outcome measures, joint manipulations, and the addition of cervico-ocular exercises for those who present with neck pain and pertinent neuromuscular comorbidities.

show abstract

“…Для детей и подростков с ги-пермобильностью суставов характерны неспецифиче-ские разлитые суставные и мышечные боли, утренняя скованность, щелчки в суставах, подвывихи и вывихи (надколенника, плеча), боль в поясничном и грудном отделах позвоночника, выпот в сустав, рецидивирую-щие растяжения связок, чувство «уязвимости суста-вов» [45,[207][208][209][210][211].…”

Section: M357 гипермобильный синдром разболтанно-сти излишней подвиunclassified

“…Во время сна неблагоприятным является длительное сгибание в локтевом и лучезапястном суставах, что может спро-воцировать туннельный синдром. Полезны регулярные перерывы и различная физическая активность с мягки-ми движениями, растяжками в течение дня [207,211].…”

Section: M357 гипермобильный синдром разболтанно-сти излишней подвиunclassified

“…При хро-нической боли необходимо исследовать пациента на наличие депрессии, например с использованием го-спитальной шкалы тревоги и депрессии (HADS). При подтверждении этого диагноза пациенту назначаются антидепрессанты из группы селективных ингибиторов обратного захвата серотонина [207][208][209][210][211]. Авитаминоз D E58 Алиментарная недостаточность кальция Жалобы и анамнез.…”

Section: M357 гипермобильный синдром разболтанно-сти излишней подвиunclassified

See 1 more Smart Citation

Guidelines of the Russian scientific medical society of internal medicine on the diagnosis, treatment and rehabilitation of patients with the connective tissue dysplasia (first edition)

Martynov¹,

Nechaeva²

2018

Medical news of the North Caucasus

View full text Add to dashboard Cite

Клинические рекомендации Российского научного медицинского общества терапевтов по диагностике, ле-чению и реабилитации пациентов с дисплазиями соединительной ткани (первый пересмотр) утверждены на XII Национальном конгрессе терапевтов 22-24 ноября 2017 года. Ключевые слова: дисплазия соединительной ткани, наследственные нарушения соединительной ткани, клинические рекомендацииClinical guidelines of the Russian Scientific Medical Society of Internal Medicine on the diagnosis, treatment and rehabilitation of patients with the connective tissue dysplasia (first edition) approved by the XII National Congress of Internists on 22-24 November 2017.

show abstract

Multimodal Chiropractic Care for Pain and Disability in a Patient Diagnosed With Ehlers-Danlos Syndrome-Hypermobility Type: A Case Report

Cited by 4 publications

References 39 publications

Management of chronic pain in Ehlers–Danlos syndrome

Management of chronic pain in Ehlers–Danlos syndrome

Manual Therapy and Exercise for the Management of Chronic Neck Pain With Multiple Neurovascular Comorbidities: A Case Report

Guidelines of the Russian scientific medical society of internal medicine on the diagnosis, treatment and rehabilitation of patients with the connective tissue dysplasia (first edition)

Contact Info

Product

Resources

About