PAIN DEFINED
“Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage." -IASP
Understanding pain and pain processing can help to identify the origins of pain and to develop treatment strategies.
People often experience more than one type of pain, and the contributions of each type may fluctuate.
PAIN CLASSIFICATIONS
Nociceptive pain arises from actual or threatened tissue damage. Nociceptors (sensory receptors) are activated to warn about actual or potential damage.
Neuropathic pain is caused by damage to the nervous system or nerve impingement.
Nociplastic pain arises from altered pain sensor processing despite no clear evidence of actual or threatened tissue damage.
PAIN & HYPERMOBILITY
Musculoskeletal pain can be a significant factor in the deterioration of quality of life for many with EDS and HSD.
The soft tissues (muscles, ligaments, and tendons) that stabilize loose joints are put under more strain. These soft tissues are also too loose, and their constant compensating make them prone to spasm and tearing. Dislocations and subluxations may also occur.
Musculoskeletal injury can begin as nociceptive or neuropathic pain and develop into nociplastic pain over time, as the nervous system becomes sensitive to amplified pain signals.
PAIN & MENTAL HEALTH
The physical and emotional challenges in EDS and HSD are complicated and overwhelming. Pain strains the system, depletes energy, disturbs sleep, and can cause irritability and depression.
Factors such as stress, anxiety, and trauma can worsen pain by raising pain sensitivity and lowering pain tolerance. Stress hormones can also increase inflammation and pain.
Whereas pain is the perceived nociceptive input from the body, suffering is the negative psychological state that happens in response to pain.
PAIN & PSYCHOTHERAPY
Psychotherapy can be part of a multi-pronged treatment approach that takes into account both physiological and psychological aspects of EDS and HSD.
It can include receiving compassionate support while navigating overwhelming challenges, gaining an understanding of the interaction between physical and emotional processes, and processing traumatic experiences.
While not all pain is trauma-related, chronic pain can be traumatic in itself. More than a physical experience, pain has existential consequences.
REFERENCES
International Association for the Study of Pain (IASP). www.iasp-pain.org.
Jovin, D. (Ed.). (2020). Disjointed: Navigating the Diagnosis and Management of hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders.
Moseley, G. L., & Butler, D.S. (2015). The Explain Pain Handbook: Protectometer.
Smith, C. (2017). Understanding Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder.
RESOURCES
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