The Relations among the Fear-Avoidance Model of Chronic Pain, Fear of Falling, and Disability in hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder

Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD) are two understudied chronic pain conditions characterized by connective tissue dysfunction with hallmark hypermobility. These conditions include disease manifestations of chronic pain, frequent dislocations, reduced muscle strength, and proprioceptive difficulties, which singularly or in combination, lead to disability. The current study examined the impact of fear-avoidance [FA] constructs (as per the FA Model of Pain, including pain catastrophizing, pain hypervigilance, pain-related fear, depression, anxiety) and fear of falling on disability in hEDS/ HSD. Group differences between hEDS/HSD participants and healthy controls were assessed. A total of 168 individuals with hEDS/HSD and 108 controls participated. Pain catastrophizing, anxiety, and fear of falling predicted 26.5% of the variance in disability, over and above pain severity and age. Participants with hEDS/HSD showed significantly higher scores on all constructs, with exception of anxiety and depression, which did not differentiate the groups. This novel work in hEDS/HSD mirrors FA studies done in other chronic pain conditions and provides evidence of the relationship between FA factors, pain experience, and disability in this patient population. Future research is needed to apply these findings to create individualized interventions that improve disability, and therefore quality of life, for the hEDS/HSD population.