Are chronic musculoskeletal pain and generalized joint hypermobility: disabling contributors to physical functioning?

Abstract

BACKGROUND\nChronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents.\n\n\nAIM\nTo evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear.\n\n\nDESIGN\nObservational, cross-sectional design.\n\n\nSETTING\nThe adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands).\n\n\nPOPULATION\nFour subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH.\n\n\nMETHODS\nOutcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear were measured. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH.\n\n\nRESULTS\nAdolescents with CMP had decreased muscle strength (p=0.01), endurance (p=0.02) and lower motor performance (p<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (p=0.01), endurance (p<0.01) and motor performance (p<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found.\n\n\nCONCLUSIONS\nAdolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP.\n\n\nCLINICAL REHABILITATION IMPACT\nNo differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to nonhypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.