Hypermobility Fibromyalgia And Chronic Pain Pdf
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- Hypermobility, Fibromyalgia and Chronic Pain
- Hypermobility, Fibromyalgia, and Chronic Pain
- Hypermobility, fibromyalgia and chronic pain
Anxiety and joint hypermobility association: a systematic review. Simone H. Crippa II.
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. The aim of this study is to investigate whether pressure pain thresholds PPTs at both symptomatic and asymptomatic body areas differ in EDS-HT patients compared to healthy subjects. 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.
Hypermobility, Fibromyalgia and Chronic Pain
Anxiety and joint hypermobility association: a systematic review. Simone H. Crippa II. Corresponding author. Among the clinical conditions found in association with anxiety stands out the joint hypermobility JH. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety.
The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Etiological explanation of the relationship between anxiety and JH is still controversial. The emotional state of anxiety is universal and has an important adaptive function.
It is generally described as a combination of somatic symptoms and subjective signs. States of anxiety are known to be present in non-clinical populations, suggesting a continuum between general and clinical populations. The clinical presentation usually consists of intense anxiety, not justified or proportional to external situations, imposing life restrictions and subjective distress. Thus, clinical cases present with interconnected physical, autonomic, and psychological alterations.
Anxiety disorders are often associated with several nonpsychiatric medical conditions. Both require attention due to the interference of symptoms in different areas of life, such as work performance, academic achievement, and daily tasks performance.
Among the clinical conditions found in association with anxiety, joint hypermobility JH is highlighted. The prevalent is higher among women raising questions about the still poorly understood hormonal influences and the Asian and African populations, with ethnic differences suggestive of genetic variations.
It is also associated with musculoskeletal dysfunctions, possibly resulting from glycoprotein deficiency and genetic alterations affecting the formation of collagen, which would explain tissue looseness and vulnerability to trauma in these patients.
The diagnosis of JH is usually established using the ninepoint Beighton scale. Aiming to allow the evaluation of hypermobility in body areas not covered in Beighton's scale, a similar methodology has been introduced and used by Bulbena et al. In addition to this clinical evaluation, it is important to mention the existence of an easily-self-administered screening instrument for the assessment of hypermobility, called 'the five-part questionnaire for identifying hypermobility', 25 which has been reported to have a high correlation with Beighton's score.
This instrument also evaluates broad body areas and considers previous history of hypermobility. In fact, the clinical presentations of JH may range from simple manifestations that do not require treatment to severe cases in which joints are more easily displaced or other clinical conditions are associated, configurating a syndrome named Hypermobility Syndrome or Benign Joint Hypermobility Syndrome.
The minor criteria serve to highlight the common physical findings of the condition. The JHS cases have a combination of marfanoid habitus, increased skin stretch, and others manifestations, such as joint subluxation or dislocation, predisposing to premature osteoarthritis. The association of joint hypermobility and anxiety was described in 10 in a case-control study of a sample of rheumatic outpatients with JH.
Subsequently, these results were replicated in a two-phase cross-sectional epidemiologycal study in a sample of 1, inhabitants. No other anxiety or mood disorders were found associated with JH. These two conditions anxiety and joint hypermobility share several common features, such as early age of onset, decreased frequency with age, high prevalence in women, and familial aggregation.
The two disorders have genetics factors that are still no well understood. Preliminary studies suggested a cytogenetic mutation in chromosome 15 in pedigrees with both disorders. Hakim et al. In recent years there is a renewed interest in studying this clinical association from a clinical, epidemiological, and biological point of view.
Articles in English, Spanish or Portuguese describing empirical studies designed to investigate the association between JH and anxiety were sought for the review. No time limits were set, and articles published up to December were included. Exclusion criteria were letters to editors, editorials, review articles, and articles reporting findings on the association between JH and conditions other than anxiety.
Selected articles were first classified according to characteristics of the population studied, study design, and psychopathologic evaluation anxiety disorder or anxiety symptoms.
Furthermore, sociodemographic characteristics, diagnostic criteria for anxiety disorders, presence of a structured interview for psychiatric diagnosis, anxiety rating scales, JH and JHS criteria, data on the prevalence and outcomes of studies on the association were extracted for a properly review.
Flow selection of articles. Thirty-four references were found via PubMed. The search in the other databases yielded no matches. Twelve articles were selected after application of the inclusion and exclusion criteria and another six were included by handsearch. Characteristics of selected articles and data extraction.
Table 4 presents the main characteristics of the 17 articles describing empirical studies on the association between JH and anxiety. The articles selected for the review were predominantly from Europe, especially Spain, with one article from Zaragoza 40 and eight from Barcelona. Selected studies were published between and We found eleven case-control studies, five cross. Assessment of anxiety, hypermobility, and joint hypermobility syndrome. We selected a group of articles reporting the diagnosis of anxiety disorder according to DSM and a second group of articles reporting symptoms or traits of anxiety without a categorical psychiatric diagnosis Table 4.
Three methods were described for the assessment of hypermobility: Beighton's score, 14 the Hospital del Mar criteria, 24 and the self-administrated join hypermobility questionnaire. Nevertheless, just two more recent studies 43,47 clearly mentioned the use of Brighton's criteria for the characterization of the musculoskeletal symptoms that constitute the syndrome. Baeza-Velasco et al. This seems to have some similarity to Beighton's proposal to use a screening questionnaire consisting of four simple questions to detect complaints of arthralgia, in his seminal article on JH.
Association between anxiety and hypermobility. Several studies found an association between anxiety symptoms or traits and JH. This review includes studies evaluating the association between anxiety and hypermobility. Differences in methodology used in most of the studies made it difficult to compare and compile results. In respect to our first outcome, the relationship between anxiety symptoms or traits and JH, most studies found a correlation between anxiety symptomatology and presence of join hypermobility.
No other anxiety disorder or mood disorder were found in association with JH. This systematic review has some limitations and strengths. The clinical samples of case-control studies showed that the studies of hypermobile patients were carried out in very different settings and three of them with a small sample size.
On the other hand, studies of anxiety patients showed more homogeneity and properly sample size to find the association. All of them use DSM criteria and three of four used a semistructured clinical interview. Raters were trained and blinded to the evaluation of hypermobility. However, one study focused on the role of MVP in the association, which limits the interpretation of the association.
The cross-sectional surveys were done in different population with different range of age and gender, which may bias the joint hypermobility prevalence. Moreover, some of them used different cut-off point of Beighton's scale or another JH tools. Lastly, there is an unusual "internet" survey based on "tall people" and the presence of JH and social phobia in a small sample to be representative.
Only one cohort study was found. Interestingly, although in a small sample size, the joint hypermobility group was associated with higher risk of developing anxiety disorders. It should be noted that several studies evaluating anxiety symptoms or traits had reported an association between anxiety and hypermobility, supporting that might be an association between some specific feature of anxiety and JH, even in non-clinical populations.
Some studies reported that patients with hypermobility had more indicators of fear trait, 42,44 which might have implications for symptoms of panic and agoraphobia and social anxiety; conditions associated with JH. Strong indicators of distress 45,46 and somatization were also found, with significant emotional symptoms resembling those of hospitalized patients regarding physical symptoms and bodily concern.
The results of the studies that investigated the prevalence of anxiety among people with hypermobility, however, were quite similar for both clinical samples and the general population. For instance, Another relevant remark is that the several studies that confirmed the association between anxiety and hypermobility were conducted in Spain, while some studies with divergent results were performed in different contexts and cultures, one in Turkey 37 and one in Israel.
These findings underscore the importance of psychometric studies with these instruments, including analyses of ROC curves and the establishment of the best cut-off points, considering mainly age, gender, and ethnic differences. Nevertheless, the most recent studies had included other measures of hypermobility, such as the self-administrated questionnaire 44 or the consideration of the syndrome according to Brighton's criteria, 21,43 suggesting a trend of increased attention to the complexity of the criteria used for identifying hypermobility.
As previously mentioned, one article studied the effect of MVP in the association of panic disorder and JH. Two more selected studies described investigations on the hypothesis that implicates MVP in the association between anxiety and hypermobility. However, these articles did not confirm the association. Thus, there seems to be a tendency toward confirming the connection between hypermobility and MVP, although the latter does not seem to have a significant impact on the association with anxiety.
Another two articles were focused on the hypothesis of the association between somatic body characteristics and anxiety disorders. These studies tested patients with thoracic deformity 48 and the asthenic somatotype. However, it is interesting to note that in their classical epidemiologic study with an African population, Beighton et al.
Additional factors commonly found in the literature on hypermobility have as yet received little attention in what concerns their association with anxiety, such as chronic pain 22,23,29,52 and non-musculoskeletal symptoms, like autonomic alterations 28,53 and inadequate proprioception. In general, the articles examined in this review tend to support the association between anxiety and JH.
Future research should considerer the study of representative, large, and prospective samples in different settings; the study of the full joint hypermobility syndrome, different anxiety disorders apart from panic and phobia disorders generalized anxiety, obsessive compulsive disorder, postraumatic disorder and anxiety traits more anxiety or fears, higher hypermobility ; as well as other psychiatric disorders highly associated with panic, such as bipolar disorders or schizophrenia or the association with other connective tissue disorders.
The study of the association is a challenging topic to perform experimental research of the link between JHS and dysautonomia, pain perception, genetic factors, or neuroimaging endophenotypes. From a clinical standpoint, it seems interesting to consider the association of anxiety in rheumatic patients. JHS may be a risk factor for future anxiety disorders and chronic medical complications ostheoartrosis, pain, loss of functionality.
Clinicians working on the field agree with the need of a multidisciplinary approach for treatment and prevention. Guidelines of the Brazilian Medical Association for the diagnosis and differential diagnosis of social anxiety disorder. Rev Bras Psiquiatr. Comorbidity and cotransmission of alcoholism, anxiety and depression. Psychol Med.
Hypermobility, Fibromyalgia, and Chronic Pain
I have been a neurologist for over three decades. During that time, I have seen many patients who had been diagnosed with fibromyalgia. The parallel between the symptoms associated with hypermobility syndrome and fibromyalgia is striking and understanding it may finally provide a path toward improved quality of life for patients who have been diagnosed with fibromyalgia. Though often suffering from a milder form of SDB, hypermobility patients experience a recurrent partial or complete collapse of the upper airway during sleep, causing fragmented sleep, frequent awakenings and overall poor quality of sleep. As a neurologist, I know that many times these symptoms are caused by pinched nerves in the back, neck, or arm. Joint pain itself is also common in various types of arthritis.
This groundbreaking new text explains and documents the scientific basis of chronic pain in Joint Hypermobility Syndrome JHS and other heritable disorders of connective tissue from the physiological, epidemiological, genetic and clinical viewpoints. It asks the reader to consider the possibility of JHS, identify it clinically, understand its co-morbidities, including interdependencies with Fibromyalgia and Chronic Fatigue Syndrome, while managing the condition appropriately. Hypermobility, Fibromyalgia and Chronic Pain takes a multi-specialty and multidisciplinary approach to understanding JHS and its management, drawing together expertise from a broad group of internationally-recognized authors. The book is split into two sections. Section 1 deals with the clinical manifestations of JHS and Fibromyalgia, their epidemiology and pathophysiology.
This groundbreaking new text explains and documents the scientific basis of chronic pain in Joint Hypermobility Syndrome JHS and other heritable disorders of connective tissue from the physiological, epidemiological, genetic and clinical viewpoints. It asks the reader to consider the possibility of JHS, identify it clinically, understand its co-morbidities, including interdependencies with Fibromyalgia and Chronic Fatigue Syndrome, while managing the condition appropriately. Hypermobility, Fibromyalgia and Chronic Pain takes a multi-specialty and multidisciplinary approach to understanding JHS and its management, drawing together expertise from a broad group of internationally-recognized authors. The book is split into two sections. Section 1 deals with the clinical manifestations of JHS and Fibromyalgia, their epidemiology and pathophysiology. Section 2 covers clinical management. Here the reader will find chapters covering pharmacotherapeutics, psychotherapy and physical therapies that address the needs of patients from childhood to adulthood.
Hypermobility, fibromyalgia and chronic pain
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Фонтейн стоял, тяжело дыша. - У нас нет причин ему не верить. - Это прозвучало как сигнал к окончанию разговора. Он отпил глоток кофе. - А теперь прошу меня извинить.