Interdisciplinary Pain Management Improves Pain and Function in Pediatric Patients with Chronic Pain Associated with Joint Hypermobility Syndrome
Open accessAbstract
Background: The relation between chronic musculoskeletal pain and joint hypermobility in a small percentage of the pediatric population is well described. However, literature discussing the treatment of chronic pain associated with joint hypermobility in pediatrics is limited. The present study examines the impact of interdisciplinary treatment on chronic pain in pediatrics with joint hypermobility syndrome. Objective: To determine if pediatric patients with chronic pain related to joint hypermobility can be effectively treated with an intensive, interdisciplinary pain management program, as measured by changes in pain, psychosocial and physical functioning, as well as parental coping. Design: Retrospective cohort study. Setting: Urban academic tertiary intensive outpatient interdisciplinary pain management clinic. Participants: The study involved 30 patients who met the criteria for a diagnosis of joint hypermobility and chronic pain and completed an interdisciplinary pain management program. Intervention: All patients were treated in an intensive pediatric interdisciplinary pain management program for a duration of 6 to 8 weeks. The program provided physical therapy, occupational therapy, psychological counseling, and weekly pediatric rehabilitation medicine follow‐up. Main Outcome Measures: Outcome measures included numeric rating scale pain scores, the Bath Adolescent Pain Questionnaire, and the Bath Adolescent Pain‐Parent Impact Questionnaire. Changes from pre‐ to post‐treatment were analyzed using paired‐samples t tests. Results: Patients endorsed pre‐ to post‐treatment improvements in pain, depression, general anxiety, pain‐related anxiety, social functioning, and physical functioning ( P < .05). The patients' parents showed significant improvements in depression, anxiety, catastrophic thinking, self‐blame and helplessness, leisure functioning, and parental behavior ( P < .05). Conclusion: The present findings suggest that an intensive interdisciplinary rehabilitation pain management program yields short‐term improvements in pain, emotional and physical function, and daily activity in a pediatric population diagnosed with joint hypermobility. Parents also experienced benefits from the program. A larger prospective study with longer‐term follow‐up is needed. Level of Evidence: III
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In chronic pain management, unlike acute pain treatment, the emphasis shifts from immediate analgesia to functional improvements in the presence of pain.
“In chronic pain management, as contrasted with acute pain treatment, the emphasis shifts from immediate analgesia to functional improvements in the presence of pain [5,6].”
From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [5]
The Treatment Protocol (page unavailable) says parents were encouraged to focus on their child's functioning rather than asking about pain, and describes therapies aimed at daily tasks and physical fitness. This supports a functional emphasis in the studied pediatric chronic-pain program, but the paper does not compare it with acute pain treatment or state that acute treatment prioritizes immediate analgesia. (LLM, conf=0.85)
Experimental — accuracy not yet measuredRevivo et al.'s cohort study found a statistically significant reduction in average pain intensity ratings, improvements in physical and social daily functioning, and reductions in depression and pain-related anxiety; almost all (97%) participants returned to school and most returned to valued activities.
“Overall, participants saw a statistically significant reduction in average pain intensity ratings, improvements in physical and social daily functioning, and reductions in depression and pain-related anxiety. Almost all (97%) participants returned to school and most patients returned to valued activities (i.e., music, sports, etc.).”
From Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review (2023) · cites this paper as [51]
Two of the included studies explicitly recommended future studies use larger sample sizes to validate the results.
“Two of the studies [32, 51] explicitly recommended future studies use larger sample sizes to validate the results.”
From Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review (2023) · cites this paper as [51]
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Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain
Harrison, L. E., Pate, J. W., Richardson, P. A., Ickmans, K., Wicksell, R. K., & Simons, L. E. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091267 · Cited by 140 · see citing works
“A recent study [5] examined the effects of an intensive day treatment program in which patients completed 1–2 half day sessions per week (lasting approximately 4 h each) for 4–8 weeks.”
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“There were four case reports [44–47], five cohort studies [32, 48–51], and one study that featured two case reports and a literature review [52].”
BackgroundMethodResultInfluential
- Authors
- Revivo, G., Amstutz, D. K., Gagnon, C. M., & McCormick, Z. L.
- Affiliations
- Northwestern University (US)
- Shirley Ryan AbilityLab (US)
- University of California, San Francisco (US)
- Corresponding author
- Revivo, Gadi
- Venue
- PM&R
- Publisher
- Wiley
- Published
- 2019-02
- Volume
- 11
- Issue
- 2
- Pages
- 150-157
- ISSN
- 1934-1482 (ISSN-L)
- 1934-1563
- OpenAlex
- W2884449151
- Cited by
- 33
- References
- 35
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 11 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PM&R (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- joint hypermobility syndrome, chronic pain, pediatric chronic pain, multidisciplinary pain management, physiotherapy, occupational therapy, psychological counseling, pain-related anxiety, parental coping, psychosocial functioning, physical function
- MeSH terms
- Adolescent, Child, Female, Follow-Up Studies, Humans, Joint Instability, Male, Pain Measurement, Surveys and Questionnaires, Retrospective Studies, Range of Motion, Articular, Treatment Outcome, Physical Therapy Modalities, Interdisciplinary Studies, Chronic Pain, Musculoskeletal Pain, Pain Management
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