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Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia

(2015) CLINICAL RHEUMATOLOGY. 34(6). p.1121-1129
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Abstract
Background: Chronic widespread pain is highly present in patients with the Ehlers-Danlos Syndrome hypermobility type (EDS-HT), but up to now, evidence for generalized hyperalgesia is lacking. Objective: To investigate whether pressure pain thresholds (PPTs) at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects. Methods: Twenty-three women with EDS-HT and 23 gender- and age-matched healthy controls participated. All subjects marked on Margolis Pain Diagram where they felt pain lasting longer than 24 hours in the past 4 weeks. Then, they completed several questionnaires assessing pain cognitions, fatigue, disability, and general health status, in order to take the possible influence of these factors on PPTs into account. Patients also completed a form concerning the type of pain they experienced. Thereupon, a blinded researcher assessed PPTs at 14 body locations on the trunk and extremities. PPTs were compared for the 2 complete groups. In addition, PPTs of patients and controls who did not report pain in a respective zone were compared. Results: PPTs of the patients were significantly lower compared to those of the control group, also when pain-free samples per zone were compared. The mean (SD) PPT was 2.9 (1.62) kg/cm2 in the EDS-HT patients and 5.2 (1.88) kg/cm2 in the controls (P<0.001). No confounding factors responsible for the observed differences could be revealed. In half of the patient group a predominantly neuropathic pain component was likely present. Conclusion: This study provides evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system, which inquires an adapted pain management for this patient group.
Keywords
Ehlers-Danlos Syndrome, Pressure pain thresholds., Central sensitization, Hyperalgesia, Pain, Joint hypermobility, QUESTIONNAIRE, THRESHOLDS, FIBROMYALGIA, MUSCULOSKELETAL PAIN, RHEUMATOID-ARTHRITIS, PRESSURE PAIN, CENTRAL SENSITIZATION, CHRONIC WIDESPREAD PAIN, LOW-BACK-PAIN, CHRONIC-FATIGUE-SYNDROME

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Chicago
Rombaut, Lies, Mark Scheper, Inge De Wandele, Janneke De Vries, Mira Meeus, Fransiska Malfait, Raoul Engelbert, and Patrick Calders. 2015. “Chronic Pain in Patients with the Hypermobility Type of Ehlers-Danlos Syndrome: Evidence for Generalized Hyperalgesia.” Clinical Rheumatology 34 (6): 1121–1129.
APA
Rombaut, L., Scheper, M., De Wandele, I., De Vries, J., Meeus, M., Malfait, F., Engelbert, R., et al. (2015). Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia. CLINICAL RHEUMATOLOGY, 34(6), 1121–1129.
Vancouver
1.
Rombaut L, Scheper M, De Wandele I, De Vries J, Meeus M, Malfait F, et al. Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia. CLINICAL RHEUMATOLOGY. 2015;34(6):1121–9.
MLA
Rombaut, Lies, Mark Scheper, Inge De Wandele, et al. “Chronic Pain in Patients with the Hypermobility Type of Ehlers-Danlos Syndrome: Evidence for Generalized Hyperalgesia.” CLINICAL RHEUMATOLOGY 34.6 (2015): 1121–1129. Print.
@article{4238373,
  abstract     = {Background: Chronic widespread pain is highly present in patients with the Ehlers-Danlos Syndrome hypermobility type (EDS-HT), but up to now, evidence for generalized hyperalgesia is lacking.
Objective: To investigate whether pressure pain thresholds (PPTs) at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects.
Methods: Twenty-three women with EDS-HT and 23 gender- and age-matched healthy controls participated. All subjects marked on Margolis Pain Diagram where they felt pain lasting longer than 24 hours in the past 4 weeks. Then, they completed several questionnaires assessing pain cognitions, fatigue, disability, and general health status, in order to take the possible influence of these factors on PPTs into account. Patients also completed a form concerning the type of pain they experienced. Thereupon, a blinded researcher assessed PPTs at 14 body locations on the trunk and extremities. PPTs were compared for the 2 complete groups. In addition, PPTs of patients and controls who did not report pain in a respective zone were compared.
Results: PPTs of the patients were significantly lower compared to those of the control group, also when pain-free samples per zone were compared. The mean (SD) PPT was 2.9 (1.62) kg/cm2 in the EDS-HT patients and 5.2 (1.88) kg/cm2 in the controls (P<0.001). No confounding factors responsible for the observed differences could be revealed. In half of the patient group a predominantly neuropathic pain component was likely present.
Conclusion: This study provides evidence for the existence of hyperalgesia even in asymptomatic areas (generalized secondary hyperalgesia). The generalized hyperalgesia may represent the involvement of a sensitized central nervous system, which inquires an adapted pain management for this patient group.},
  author       = {Rombaut, Lies and Scheper, Mark and De Wandele, Inge and De Vries, Janneke and Meeus, Mira and Malfait, Fransiska and Engelbert, Raoul and Calders, Patrick},
  issn         = {0770-3198},
  journal      = {CLINICAL RHEUMATOLOGY},
  keywords     = {Ehlers-Danlos Syndrome,Pressure pain thresholds.,Central sensitization,Hyperalgesia,Pain,Joint hypermobility,QUESTIONNAIRE,THRESHOLDS,FIBROMYALGIA,MUSCULOSKELETAL PAIN,RHEUMATOID-ARTHRITIS,PRESSURE PAIN,CENTRAL SENSITIZATION,CHRONIC WIDESPREAD PAIN,LOW-BACK-PAIN,CHRONIC-FATIGUE-SYNDROME},
  language     = {eng},
  number       = {6},
  pages        = {1121--1129},
  title        = {Chronic pain in patients with the hypermobility type of Ehlers-Danlos syndrome: evidence for generalized hyperalgesia},
  url          = {http://dx.doi.org/10.1007/s10067-014-2499-0},
  volume       = {34},
  year         = {2015},
}

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