Exploring signs of central sensitization in adolescents with hypermobility Spectrum disorder or hypermobile Ehlers-Danlos syndrome

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-11-11 DOI:10.1002/ejp.4754

Elke Schubert-Hjalmarsson, Anders Fasth, Kelly Ickmans, Ann-Charlott Söderpalm, Mari Lundberg

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Abstract

Background

Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) are two overlapping heritable connective tissue disorders characterized by joint hypermobility, chronic pain, impaired body perception, and musculoskeletal symptoms. Central sensitization has been proposed as a plausible explanation for symptoms like widespread pain, fatigue, mood disorders, and sleep disturbances in patients with HSD/hEDS.

Objective

The aim of this study was to investigate signs of central sensitization, including exercise-induced hypoalgesia (EIH), and fatigue severity in adolescents with HSD/hEDS.

Methods

In this prospective, experimental, case–control study, thirty-seven adolescents with HSD/hEDS and 47 healthy adolescents (all aged 13–17 years) were included. Pressure pain thresholds (PPTs) were measured at four muscle groups using a pressure algometer. EIH was evaluated by measuring PPTs on two muscle groups immediately after an exercise test on a bicycle ergometer. Participants also completed questionnaires on fatigue and cognitive/emotional factors.

Results

The study demonstrated significantly lower PPTs in four different muscle groups in adolescents with HSD/hEDS compared to the healthy control group. Both groups achieved a significantly higher PPTs after exercise in the muscle involved in the activity. Adolescents with HSD/hEDS reported higher fatigue levels and more cognitive/emotional difficulties than the control group.

Conclusion

Adolescents with HSD/hEDS showed generalized hyperalgesia measured through PPTs at different body sites. EIH was partly affected in adolescents with HSD/hEDS, presenting as unchanged pain sensitivity in the remote muscle. Pain should be considered as a phenomenon that is influenced by different biopsychosocial factors, including possible central sensitization, which increase its complexity.

Significance statement

This study breaks new ground by showing signs of central sensitization, including diminished EIH, in adolescents with HSD or hEDS. Given that exercise is a key element in pain management, these findings offer valuable insights when developing treatment plans for adolescents with HSD or hEDS.

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探索患有活动过度频谱障碍或活动过度埃勒斯-丹洛斯综合征的青少年的中枢敏感化迹象。

背景：活动过度频谱障碍（HSD）和活动过度埃勒斯-丹洛斯综合征（hEDS）是两种重叠的遗传性结缔组织疾病，其特征是关节活动过度、慢性疼痛、身体知觉受损和肌肉骨骼症状。中枢敏化被认为是 HSD/hEDS 患者广泛性疼痛、疲劳、情绪障碍和睡眠障碍等症状的一种合理解释：本研究旨在调查患有 HSD/hEDS 的青少年的中枢敏化迹象，包括运动诱发的低痛感（EIH）和疲劳严重程度：在这项前瞻性、实验性、病例对照研究中，共纳入了 37 名患有 HSD/hEDS 的青少年和 47 名健康青少年（年龄均为 13-17 岁）。研究人员使用压痛计测量了四个肌肉群的压痛阈值（PPT）。在自行车测力计上进行运动测试后，立即测量两组肌肉的压痛阈值，以评估 EIH。参与者还填写了有关疲劳和认知/情绪因素的问卷：研究表明，与健康对照组相比，患有 HSD/hEDS 的青少年四个不同肌肉群的 PPT 值明显较低。两组青少年在运动后参与活动的肌肉的 PPT 值都明显较高。与对照组相比，患有 HSD/hEDS 的青少年表现出更高的疲劳度和更多的认知/情感困难：结论：患有 HSD/hEDS 的青少年通过身体不同部位的 PPTs 测量，表现出全身性痛觉减退。HSD/hEDS 青少年的 EIH 部分受到影响，表现为远处肌肉的痛觉敏感性不变。疼痛应被视为一种受不同生物心理社会因素影响的现象，包括可能的中枢敏感化，这增加了疼痛的复杂性：本研究开创性地显示了患有 HSD 或 hEDS 的青少年中枢敏感化的迹象，包括 EIH 的减弱。鉴于运动是疼痛治疗的关键因素，这些发现为制定 HSD 或 hEDS 青少年的治疗计划提供了宝贵的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.