ABSTRACT
OBJECTIVE: Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia. METHODS: Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression. RESULTS: Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). 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, hypermobility, and healthy controls (odds ratio 6.0). CONCLUSION: Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain.
Subject(s)
Chronic Pain/etiology , Ehlers-Danlos Syndrome/complications , Hyperalgesia/etiology , Joint Instability/complications , Joints/physiopathology , Pain Threshold , Adolescent , Adult , Age Factors , Belgium , Biomechanical Phenomena , Case-Control Studies , Child , Chronic Pain/diagnosis , Chronic Pain/physiopathology , Diagnosis, Differential , Discriminant Analysis , Ehlers-Danlos Syndrome/diagnosis , Ehlers-Danlos Syndrome/physiopathology , Ehlers-Danlos Syndrome/psychology , Female , Humans , Hyperalgesia/diagnosis , Hyperalgesia/physiopathology , Joint Instability/diagnosis , Joint Instability/physiopathology , Joint Instability/psychology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Netherlands , New South Wales , Odds Ratio , Pain Measurement , Predictive Value of Tests , Risk Factors , Young AdultABSTRACT
OBJECTIVES: To study self reported knee joint problems and the energy costs of level walking in soccer players. METHODS: Seventeen soccer players and twelve control subjects between 18 and 27 years old participated in the study. A questionnaire was used to establish the amount of participation in soccer and the frequency and extent of knee injuries. The physiological cost index (PCI) was used as an index of the energy costs of level walking. RESULTS: Soccer players had a significantly higher PCI than control subjects (p = 0.0001). Control subjects had a mean (SD) PCI of 0.23 (0.06) beats/m and soccer players had a mean PCI of 0.42 (0.12) beats/m. Some 82% of the soccer players experienced knee joint problems, whereas only 25% of the control group had problems. CONCLUSIONS: This study shows that college soccer players have a higher rate of self reported knee problems and higher energy costs of level walking than people who do not play soccer.
