van Meulenbroek Thijs, Huijnen Ivan P J, Simons Laura E, Conijn Arnoud E A, Engelbert Raoul H H, Verbunt Jeanine A
Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.
and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands.
Scand J Pain. 2020 Aug 31;21(1):22-31. doi: 10.1515/sjpain-2020-0023. Print 2021 Jan 27.
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.
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.
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.
相当一部分患有慢性肌肉骨骼疼痛（CMP）的青少年在身体功能、情绪和社交功能方面存在困难，导致生活质量下降。全身关节活动过度（GJH）是发生CMP的一个风险因素，有35%至48%的CMP患者报告有GJH，这一比例惊人。如果GJH伴有一种或多种肌肉骨骼表现，如慢性疼痛、创伤、本体感觉障碍和关节不稳定，则被称为全身活动过度谱系障碍（G-HSD）。在患有活动过度型埃勒斯-当洛综合征（hEDS）的儿童和青少年中也报告了类似特征。在CMP的管理中，建议采用生物心理社会方法，因为多项研究证实了心理社会因素在CMP发生和维持中的作用。恐惧回避模型（FAM）是一种认知行为框架，描述了与疼痛相关的恐惧作为CMP相关残疾的决定因素的作用。
使用PubMed来识别关注慢性肌肉骨骼疼痛、全身关节活动过度、与疼痛相关的恐惧和残疾的现有相关文献。对相关文章进行交叉引用，以识别在初步筛选过程中可能遗漏的文章。本文针对有和没有CMP的活动过度青少年，介绍了FAM各个单独组成部分的科学证据现状。基于此概述，提出了FAM，以解释GJH、与疼痛相关的恐惧和残疾之间关系中可能的潜在机制。
据推测，GJH似乎会使你更容易受伤，并经历更频繁的肌肉骨骼疼痛。此外，还提出了与疼痛相关的恐惧加剧的易感性，作为解释GJH与残疾之间关系的潜在机制。需要对这种应用的FAM进行进一步的科学证实，以进一步揭示潜在机制。在解释G-HSD/hEDS个体的残疾问题时，重要的是既要关注与关节活动过度相关的身体组成部分，又要关注与疼痛相关的恐惧、灾难化思维和广泛性焦虑等心理组成部分。
