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Half of teens with fibromyalgia have ‘loose’ joints, may be more pain-sensitive subset

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Article:
The role of benign joint hypermobility in the pain experience in Juvenile Fibromyalgia: an observational study – Source: Pediatric Rheumatology Online Journal, Jun 15, 2012

[Note: the full text of this article is available free here. Other research, in women with hypermobile joints (able to extend joints beyond what is considered ‘normal’), found that 75% of them also suffer from migraines (“’Loose Joints’ Highly Associated with migraine.” Statistics also indicate that joint hypermobility often co-occurs with orthostatic intolerance and/or chronic fatigue syndrome.)]

Abstract:
Background: Juvenile Fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain, and approximately 40% of children and adolescents with JFM also suffer from benign joint hypermobility (HM). It is not currently known if the presence of HM affects the pain experience of adolescents with JFM.

The objective of this study was to examine whether there were any differences in self-reported pain intensity and physiologic pain sensitivity between JFM patients with and without joint HM.

Methods: 131 adolescent patients with JFM [ages 11-18] recruited from four pediatric rheumatology clinics completed a daily visual analogue scale (VAS) pain rating for one week and underwent a standardized 18-count tender point (TP) dolorimeter assessment.

Medical records were reviewed for the presence of joint hypermobility. Average pain VAS ratings, tender point count and tender point sensitivity were compared between JFM patients with and without hypermobility (HM + and HM-).

Results

• Nearly half (48%) the sample of JFM patients were found to be HM+.

• HM + and HM- patients did not differ in their self-reported pain intensity.

• However, HM + patients had:
– Significantly greater pain sensitivity,
– With lower tender point thresholds (p = 0.002)
– And a greater number of painful tender points (p = 0.003) compared to HM- patients.

Conclusion: The presence of joint hypermobility among adolescent patients with JFM appears to be associated with enhanced physiologic pain sensitivity, but not self-report of clinical pain.

Further examination of the mechanisms for increased pain sensitivity associated with joint hypermobility, especially in adolescents with widespread pain conditions such as JFM is warranted.

Source: Pediatric Rheumatology Online Journal, Jun 15, 2012. PMID:22704360, by Ting TV, Hashkes PJ, Schikler K, Desai AM, Spalding S, Kashikar-Zuck S. Divisions of Rheumatology, Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, OH; Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel; Division of Pediatric Rheumatology, University of Louisville, KY; Center of Pediatric Rheumatology, Cleveland Clinic, Cincinnati, OH, USA. [Email:
tracy.ting@cchmc.org]

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