Generalized Hyperalgesia in children and adults diagnosed with Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility type: A discriminative analysis.

Lowered pressure pain thresholds have been demonstrated in adults with Ehlers-Danlos Hypermobility type(EDS-HT), however it remains unclear if these findings are also present in children. Therefore, the objectives of the study were to: (1)determine if generalized hyperalgesia is present in Hypermobility syndrome (HMS)/EDS-HT children, (2)explore potential differences in pressure pain thresholds between HMS/EDS-HT children and adults, and (3)determine the discriminative value of generalized hyperalgesia. Patients classified in one of three groups: HMS/EDS-HT, hypermobile (Beighton score ≥4/9) and healthy controls. Descriptive data of age, gender, body mass index, Beighton score, skin laxity and medication usage were collected. Generalized hyperalgesia was quantified by the averaged pressure pain thresholds collected from 12 locations. The following confounders were collected: pain locations/intensity, fatigue, psychological distress. Comparisons between HMS/EDS-HT children and normative values, between children and adults with HMS/EDS-HT, corrected confounders, were analysed with MANCOVA. The discriminative value of generalized hyperalgesia employed in order to differentiate between HMS/EDS-HT, hypermobile and controls was quantified with logistic regression. Significantly lower pressure pain thresholds were found in children with HMS/EDS-HT compared to normative values (range: -22.0% to -59.0%, p=<.05). When applying a threshold of 30.8 N/cm2 for males and 29.0 N/cm2 for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobile and healthy controls (odds ratio=6.0).

Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, as well as generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain.