Exploring the relationship between joint hypermobility and chronic pain in youth: Diagnostic challenges and the Beighton Scale.

Abstract

Joint hypermobility is a common concern in youth with chronic widespread pain though its relationship with chronic pain is not fully understood. The Beighton Scale is often used to assess hypermobility, but concerns exist about its reliability and subjectivity. To determine the prevalence of positive Beighton Scale scores in youth with chronic pain, describe Beighton Scale scoring consistency and its association with hypermobility-related diagnoses, and assess the relationship between chronic pain, hypermobility, and subluxation. A retrospective chart review of youth seen in a pediatric chronic pain clinic over a 1-year period was conducted. Data were collected from electronic medical records, including Beighton Scale scores, hypermobility-related diagnoses, and pain assessments. Of the 164 youth meeting inclusion criteria for this study, 134 had documented Beighton Scale scores, and 46.7% had a positive Beighton Scale score. However, there were conflicting scores in 52.7% of youth with ratings from two or more providers. A hypermobility-related diagnosis was given to 37% of youth, with nine different diagnoses used. Diagnoses were often provided even with negative Beighton Scale scores, highlighting inconsistencies in diagnostic criteria. Among patients with detailed hypermobility descriptions, 75.5% had pain in hypermobile joints, though 97.3% reported pain in nonhypermobile areas, and 56.4% had painless hypermobile joints. Hypermobility was a common finding in youth with chronic pain, highlighting the importance of assessing hypermobility during evaluations. However, this study raises concerns about the inconsistency in diagnosing and documenting hypermobility and variability in Beighton Scale scoring. These findings suggest a need for standardized diagnostic criteria and clinician training to improve diagnostic accuracy. Pain often extends beyond hypermobile joints, suggesting hypermobility may not fully explain chronic pain in this population. Providers should emphasize physical therapy and multidisciplinary treatment approaches in managing youth with chronic pain and hypermobility concerns.