Are There Medications That Help with Hypermobility Pain?

Understanding Pain in Hypermobility

Hypermobility, often associated with conditions such as Ehlers-Danlos Syndrome (EDS) and Joint Hypermobility Syndrome (JHS), can cause significant pain that affects daily life. While some individuals experience mild discomfort, others suffer from chronic pain that requires medical intervention. Understanding the different types of pain and their underlying causes is essential to determining the most effective treatment options.

Types of Pain Experienced

People with hypermobility often experience a variety of pain types, including:

• Joint and Muscle Pain – Due to joint laxity and instability, muscles must work harder to compensate for weak connective tissues, leading to fatigue and soreness. This pain is often exacerbated by repetitive movements, prolonged activity, or poor posture.
• Neuropathic Pain (Nerve-Related Pain) – Nerve irritation or compression can result in shooting, burning, or tingling pain, particularly in areas where hypermobile joints cause nerve impingement.
• Chronic Widespread Pain (Similar to Fibromyalgia) – Many individuals with hypermobility experience a deep, aching pain that affects multiple areas of the body. This pain may be linked to dysfunction in pain processing pathways, making it more challenging to manage.

Causes of Pain in Hypermobility

Several factors contribute to the pain experienced by individuals with hypermobility:

• Joint Instability and Frequent Subluxations/Dislocations – Hypermobile joints are prone to partial or complete dislocations, leading to acute pain and long-term damage to surrounding tissues. This instability increases the risk of osteoarthritis, further exacerbating pain.
• Connective Tissue Dysfunction and Inflammation – Weak collagen and lax connective tissues lead to micro-injuries and inflammation, causing persistent discomfort. Tendons and ligaments struggle to provide adequate support, resulting in increased stress on muscles and joints.
• Nerve Sensitivity and Central Sensitisation – In some individuals, the nervous system becomes hypersensitive, amplifying pain signals. This phenomenon, known as central sensitisation, can make even minor stimuli feel disproportionately painful, complicating treatment.

Medications Commonly Used for Hypermobility Pain

Below is a breakdown of the most commonly used medications for hypermobility-related pain.

Over-the-Counter Pain Relievers

For mild to moderate pain, over-the-counter (OTC) medications can provide temporary relief. These drugs are often the first line of defence before considering prescription options.

• Acetaminophen (Tylenol): General Pain Relief
  Acetaminophen is widely used for mild to moderate pain relief. While it does not reduce inflammation, it can help with general aches and discomfort associated with hypermobility.
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen, Naproxen for Inflammation
  NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve) help reduce pain and inflammation, making them useful for individuals experiencing joint pain and swelling. However, because hypermobility pain is often not primarily caused by inflammation, their effectiveness can vary.
• Considerations for Long-Term NSAID Use
  While NSAIDs can provide short-term relief, prolonged use comes with risks:
  • Gastrointestinal Issues – Long-term NSAID use can lead to stomach irritation, ulcers, and acid reflux.
  • Cardiovascular Risks – Chronic use of NSAIDs may increase the risk of heart-related issues, particularly in individuals with pre-existing conditions.
  • Kidney Concerns – Prolonged NSAID consumption can impact kidney function, particularly in those with underlying kidney disease.

Prescription Medications

For individuals with moderate to severe pain that does not respond to OTC medications, prescription options may be necessary. These medications target different types of pain, from muscle spasms to nerve-related discomfort.

• Muscle Relaxants: Cyclobenzaprine, Baclofen for Muscle Spasms
  Muscle relaxants such as cyclobenzaprine (Flexeril) and baclofen help alleviate muscle tightness and spasms, which are common in hypermobile individuals. These medications may be particularly helpful for those experiencing secondary muscle pain due to overcompensation for weak joints.
• Neuropathic Pain Medications
  Some hypermobile individuals develop neuropathic pain, where the nervous system becomes overactive or overly sensitive. Medications that target nerve pain include:
  • Gabapentin (Neurontin) and Pregabalin (Lyrica) for Nerve Pain
    These drugs help reduce nerve excitability and are commonly used to treat chronic nerve-related pain. They may be particularly helpful for individuals experiencing burning, tingling, or shooting pains.
  • Duloxetine (Cymbalta) and Amitriptyline for Central Pain Modulation
    These medications, originally developed as antidepressants, are frequently prescribed for chronic pain conditions like fibromyalgia and central sensitisation syndrome. They work by increasing neurotransmitter levels in the brain, which can help regulate pain perception.
• Low-Dose Naltrexone (LDN): Emerging Treatment for Chronic Pain and Inflammation
  Low-dose naltrexone (LDN) is an experimental but promising treatment for chronic pain in hypermobility-related conditions such as Ehlers-Danlos Syndrome (EDS). LDN works by modulating immune function and reducing chronic inflammation. Some studies suggest that it may help alleviate widespread pain and fatigue, but more research is needed.
• Opioids (Rarely Recommended): Risks vs. Benefits in Hypermobility Pain
  Opioid medications such as tramadol, codeine, or oxycodone are generally not recommended for hypermobility-related pain due to their limited effectiveness in chronic pain conditions and high potential for dependence. Additionally, hypermobile individuals often have an altered pain response that can make opioids less effective or lead to paradoxical effects.

Medications for Specific Symptoms

Because hypermobility affects multiple body systems, some individuals may require medications that target specific symptoms beyond just joint and muscle pain.

• Joint and Ligament Pain: Hyaluronan Injections for Joint Lubrication
  Hyaluronan (Hyaluronic Acid) injections are sometimes used for individuals experiencing joint pain due to cartilage wear and tear. This treatment is more common in cases where hypermobility has led to early-onset osteoarthritis.
• Dysautonomia-Related Pain: Beta-Blockers, Fludrocortisone for Autonomic Dysfunction Symptoms
  Many individuals with hypermobility experience dysautonomia, a condition that affects autonomic nervous system regulation. This can lead to lightheadedness, palpitations, and blood pressure instability. Common medications include:
  • Beta-Blockers (Propranolol, Atenolol) – Help regulate heart rate and blood pressure, reducing symptoms like dizziness and tachycardia (fast heart rate).
  • Fludrocortisone – A medication that helps retain sodium and water, preventing low blood pressure episodes (orthostatic hypotension).
• Gastrointestinal Pain: Medications for IBS and Gastroparesis in Hypermobile Individuals
  Many people with hypermobility also experience gastrointestinal issues such as Irritable Bowel Syndrome (IBS) or Gastroparesis (delayed stomach emptying). These symptoms can contribute to chronic abdominal pain and digestive distress. Treatment options include:
  • Antispasmodic Medications (Hyoscine, Dicyclomine) – Help reduce gut spasms in individuals with IBS.
  • Prokinetic Drugs (Domperidone, Erythromycin) – Help improve stomach motility in individuals with gastroparesis.
  • Laxatives or Fibre Supplements – May be required for constipation-predominant IBS.

Non-Medication Approaches for Managing Hypermobility Pain

Physical Therapy and Strength Training

One of the most effective ways to manage hypermobility pain is through physical therapy and strength training. These techniques focus on strengthening muscles, improving posture, and increasing joint stability to prevent excessive movement that can lead to pain and injury.

• Importance of Joint Stabilisation
  Individuals with hypermobility often experience joint instability, which can lead to frequent subluxations (partial dislocations) and dislocations. Strengthening the muscles surrounding hypermobile joints can provide much-needed support, reducing the likelihood of injuries. A physiotherapist or occupational therapist can design a customised exercise plan to improve proprioception (body awareness) and muscle control.
• Exercises That Minimise Strain on Joints
  Traditional high-impact workouts can be harmful to hypermobile individuals, as they may increase the risk of joint injuries. Instead, low-impact and controlled exercises are recommended, including:
  • Isometric Exercises – Holding positions that strengthen muscles without putting excessive strain on joints (e.g., planks, wall sits).
  • Resistance Band Workouts – Strengthening muscles with controlled movements that provide support without overstretching.
  • Hydrotherapy (Water-Based Exercise) – Swimming and water aerobics help build muscle strength while reducing the impact on joints.
  • Pilates and Yoga (with Caution) – These practices improve core strength, flexibility, and body awareness, but hypermobile individuals should avoid overstretching or extreme poses that could worsen joint instability.

Bracing and Supportive Devices

For individuals who struggle with joint instability and pain, bracing and supportive devices can provide structural support and prevent excessive movement that may lead to injuries.

• When to Use Braces, Splints, or Orthotics
  Braces and splints can be used proactively to support weak joints or reactively after an injury to promote healing. Orthotic insoles can help improve foot alignment and reduce strain on the knees, hips, and lower back. However, over-reliance on braces can sometimes lead to muscle weakening, so they should be used strategically and in consultation with a healthcare professional.
• How They Help Prevent Joint Overextension
  Hypermobile individuals often have joints that move beyond the normal range of motion. Braces and splints can help:
  • Limit excessive movement, preventing subluxations and dislocations.
  • Reduce pain and fatigue by providing additional stability.
  • Improve proprioception, helping individuals gain better awareness of their joint positioning.

Common braces used for hypermobility include:

• Knee braces for individuals prone to patellar instability.
• Wrist splints to support weak wrists and prevent strain from repetitive tasks.
• Thumb and finger splints for individuals experiencing frequent dislocations in the hands.

Lifestyle Modifications

Making small yet effective lifestyle modifications can significantly impact pain levels and overall well-being for individuals with hypermobility.

• Managing Activity Levels to Avoid Overuse Injuries
  People with hypermobility often experience the “boom and bust” cycle, where they feel well and engage in excessive activity, only to suffer from extreme pain and fatigue afterward. Pacing activities can help prevent overuse injuries and reduce pain flare-ups. Strategies include:
  • Breaking tasks into smaller segments rather than doing them all at once.
  • Taking frequent breaks to avoid prolonged strain on joints.
  • Using ergonomic tools (e.g., cushioned keyboards, adaptive utensils) to reduce unnecessary joint stress.
• Sleep and Stress Management Techniques
  Poor sleep quality and chronic stress can exacerbate pain levels. Developing a structured sleep routine and incorporating relaxation techniques can help manage symptoms more effectively.
  • Sleep Hygiene Tips:
    • Using supportive pillows and mattresses to maintain proper spinal alignment.
    • Establishing a consistent sleep schedule to regulate the body’s internal clock.
    • Managing pain before bed with heat therapy, gentle stretching, or relaxation techniques.
  • Stress Reduction Strategies:
    • Mindfulness and Meditation: Can help reduce anxiety and improve pain tolerance.
    • Breathing Exercises: Techniques such as diaphragmatic breathing can calm the nervous system and reduce pain perception.
    • Cognitive Behavioural Therapy (CBT): A psychological approach that helps individuals develop coping strategies for chronic pain.

How to Find Pain Specialists Familiar with Hypermobility Conditions

Finding a healthcare professional who understands hypermobility disorders can be challenging, as these conditions are often overlooked or misdiagnosed. Here are some steps to locate specialists with experience in treating hypermobility-related pain:

• Look for Ehlers-Danlos Syndrome (EDS) and Hypermobility Clinics – Some hospitals and research centres have dedicated clinics for hypermobility disorders, particularly in rheumatology, pain management, or genetics departments.
• Ask for Referrals from a Rheumatologist or GP – If your primary doctor is unfamiliar with hypermobility-related pain, they may be able to refer you to a specialist in pain medicine, physiotherapy, or neurology.
• Join Support Groups and Online Communities – Patient communities, such as those on Facebook, Reddit, or Ehlers-Danlos Society forums, often share recommendations for knowledgeable doctors in different regions.
• Check Specialist Directories – Organisations such as The Ehlers-Danlos Society, The Hypermobility Syndromes Association (HMSA), and Dysautonomia International often have doctor directories listing professionals familiar with hypermobility.

Seek Physiotherapists and Occupational Therapists with Hypermobility Experience – Many manual therapists, physiotherapists, and OTs specialise in joint hypermobility rehabilitation and can provide valuable support even if a medical diagnosis has not been confirmed.