Pain-Related Fear and Its Disabling Impact in Hypermobile Adolescents With Chronic Musculoskeletal Pain
Open accessAbstract
Study Design: Cross-sectional study. Background: Chronic musculoskeletal pain (CMP) has a negative impact on physical functioning. During adolescence, joint hypermobility is a potential risk factor for developing CMP, and pain-related fear contributes to the persistence of CMP. Whether pain-related fear and hypermobility are related, and even reinforce each other, resulting in a stronger association with perceived level of disability, is still unknown. Objectives: To evaluate whether pain-related fear has a stronger association with disability in hypermobile compared to nonhypermobile adolescents with CMP. Methods: The study included 116 adolescents with CMP. The presence of hypermobility was assessed using the Beighton score. Measures of pain intensity, age, sex, and pain-related fear were collected and included in the multivariable model. Hierarchical regression analysis, with disability as the dependent variable, was used to examine the interaction between hypermobility and pain-related fear. Results: Hypermobile adolescents with CMP do not have more pain-related fear compared to nonhypermobile adolescents with CMP. There was no interaction effect between hypermobility and pain-related fear in explaining disability (β = .20, P = .42). Similarly, perceived harmfulness of balance-related activities was not more strongly associated with disability in hypermobile adolescents with CMP. Conclusion: The association of pain-related fear with the perceived level of disability is not more pronounced in hypermobile compared to nonhypermobile adolescents with CMP. J Orthop Sports Phys Ther 2017;47(10):775–781. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7282
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Recent research indicates that, in adolescents, chronic pain-not GJH-may be the primary driver of fear and disability.
“Recent research indicates that, in adolescents, chronic pain—not GJH—may be the primary driver of fear and disability.25”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [25]
The indexed Abstract reports that adolescents with chronic musculoskeletal pain had similar pain-related fear whether or not they were hypermobile, and that hypermobility did not strengthen the association between fear and disability. But all 116 participants had chronic pain, so the study does not establish that pain, rather than GJH, is the primary driver of fear and disability among adolescents generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe level of catastrophizing and pain intensity does not differ between adolescents with or without hypermobility and chronic musculoskeletal pain.
“Also, the level of catastrophizing and pain intensity did not differ between adolescents with or without hypermobility and CMP.25,57”
From Role of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review (2025) · cites this paper as [25]
The Abstract reports that hypermobile adolescents with chronic musculoskeletal pain did not have more pain-related fear than nonhypermobile adolescents. It does not report a comparison of catastrophizing, and although it says pain intensity was measured, it gives no between-group result for pain intensity (searched: catastrophizing, pain intensity, and the claimed comparison). (LLM, conf=0.72)
Experimental — accuracy not yet measured
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Cites
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Beighton Score: A Valid Measure for Generalized Hypermobility in Children
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van Meulenbroek, T., Huijnen, I. P. J., Simons, L. E., Conijn, A. E. A., Engelbert, R. H. H., & Verbunt, J. A. (2021) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0023 · Cited by 30 · see citing works
Self-citationRole of Anxiety in Individuals with Generalized Joint Hypermobility: A Systematic Review
van Die-de Vries, J. E., Rameckers, E., Calders, P., Engelbert, R. H., Ramaekers, S. P., Goossens, M. E., & Verbunt, J. A. (2025) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2025.100467 · Cited by 1 · see citing works
Self-citation
- Authors
- van Meulenbroek, T., Huijnen, I. P. J., Wiertz, C. M. H., & Verbunt, J. A.
- Venue
- Journal of Orthopaedic & Sports Physical Therapy
- Published
- 2017-10
- Volume
- 47
- Issue
- 10
- Pages
- 775-781
- ISSN
- 0190-6011 (ISSN-L)
- 1938-1344
- OpenAlex
- W2754107249
- Cited by
- 8
- References
- 13
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 3 · 2020: 2 · 2017: 1
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Journal of Orthopaedic and Sports Physical Therapy (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Universiteit Maastricht
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- fear of pain, chronic musculoskeletal pain, joint hypermobility, adolescents, disability, Beighton score, fear-avoidance beliefs, physical function
- MeSH terms
- Adolescent, Child, Cross-Sectional Studies, Disability Evaluation, Female, Humans, Joint Instability, Male, Pain Measurement, Perception, Phobic Disorders, Risk Factors, Young Adult, Chronic Pain, Musculoskeletal Pain
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