Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain

T. van Meulenbroek*, I.P.J. Huijnen, L.E. Simons, A.E.A. Conijn, R.H.H. Engelbert, J.A. Verbunt

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review


Objectives: A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability.Content: Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability.Summary and outlook: It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
Original languageEnglish
Pages (from-to)22-31
Number of pages10
JournalScandinavian Journal of Pain
Issue number1
Publication statusPublished - 1 Jan 2021


  • children
  • chronic musculoskeletal pain
  • ehlers-danlos-syndrome
  • fear-avoidance model
  • generalized hypermobility spectrum disorder
  • generalized joint hypermobility
  • hypermobile ehlers-danlos syndrome
  • knee function
  • low-back-pain
  • muscle strength
  • pain-related disability
  • proprioception
  • quality-of-life
  • risk-factor
  • hypermobile Ehlers-Danlos syndrome


Dive into the research topics of 'Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain'. Together they form a unique fingerprint.

Cite this