Expert opinion on pharmacotherapy · 2026
Pharmacotherapeutic management of chronic pain in joint hypermobility and Ehlers-Danlos syndromes: a clinical perspective.
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Castori Marco
Аннотация
INTRODUCTION: Joint hypermobility-related pain is an increasingly recognized musculoskeletal pain characterized by mixed pain mechanisms, frequent chronicity, and an incompletely defined natural history. Joint hypermobility-related pain may occur in monogenic Ehlers-Danlos syndromes, but it is more frequently encountered in people with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome, conditions that remain molecularly unresolved.
AREAS COVERED: This article places joint hypermobility-related pain in its historical and conceptual context, summarizes the mechanisms thought to contribute to its development, and critically reviews pharmacotherapeutic evidence identified in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and WHO ICTRP without date restrictions.
EXPERT OPINION: Current evidence is low-level and does not support the efficacy of any disease-specific, repurposed, or novel drug for joint hypermobility-related pain. Medication alone may be appropriate for occasional or recurrent pain and predominantly nociceptive flares. Chronicity, musculoskeletal disability, and overlapping nociceptive, neuropathic, and nociplastic mechanisms limit the effectiveness of drug-only strategies and envisage multimodal management. Pharmacological approach should stand on one drug at a time, usually at a low dose, and benefit and adverse burden should be reassessed after a predefined trial. Patients are best managed by keeping the diagnostic and therapeutic pathways separate.
AREAS COVERED: This article places joint hypermobility-related pain in its historical and conceptual context, summarizes the mechanisms thought to contribute to its development, and critically reviews pharmacotherapeutic evidence identified in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and WHO ICTRP without date restrictions.
EXPERT OPINION: Current evidence is low-level and does not support the efficacy of any disease-specific, repurposed, or novel drug for joint hypermobility-related pain. Medication alone may be appropriate for occasional or recurrent pain and predominantly nociceptive flares. Chronicity, musculoskeletal disability, and overlapping nociceptive, neuropathic, and nociplastic mechanisms limit the effectiveness of drug-only strategies and envisage multimodal management. Pharmacological approach should stand on one drug at a time, usually at a low dose, and benefit and adverse burden should be reassessed after a predefined trial. Patients are best managed by keeping the diagnostic and therapeutic pathways separate.