The role of benign joint hypermobility in the pain experience in Juvenile Fibromyalgia: an observational study

Tracy V Ting,Anjali M Desai,Susmita Kashikar-Zuck,Kenneth Schikler,Philip J Hashkes,Steven Spalding

doi:10.1186/1546-0096-10-16

Abstract

BackgroundJuvenile 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.MethodsOne hundred thirty-one adolescent patients with JFM 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 HM. Average pain VAS ratings, tender point count and tender point sensitivity were compared between JFM patients with and without hypermobility (HM+ and HM-).ResultsNearly 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 TP thresholds (p = 0.002) and a greater number of painful TPs (p = 0.003) compared to HM- patients.ConclusionThe presence of HM 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 HM, especially in adolescents with widespread pain conditions such as JFM is warranted.

Highlights

Juvenile Fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain and approximately 40% of children and adolescents with JFM suffer from benign joint hypermobility (HM)
Among the 18 tender point (TP) sites, TP locations with the lowest mean pain threshold were in the head and neck region with lower average thresholds consistently seen among the HM group (Figure 1A/B)
In correlations between selfreported visual analogue scale (VAS) and pain sensitivity measures based upon dolorimetry, neither TP score (Pearson r = -0.08) nor TP count (Spearman ρ = 0.06) was significantly associated with VAS self-report of pain intensity (Table 3)

Summary

Introduction

Juvenile Fibromyalgia (JFM) is characterized by chronic widespread musculoskeletal pain and approximately 40% of children and adolescents with JFM suffer from benign joint hypermobility (HM). It is not currently known if the presence of HM affects the pain experience of adolescents with JFM. Juvenile fibromyalgia (JFM) is a chronic condition of widespread musculoskeletal pain and fatigue in children and adolescents. Children and adolescents with increased joint laxity have been found to frequently suffer from chronic musculoskeletal pain complaints [5,6], one large population study indicated no such association [7].

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