Chronic Widespread Pain and Central Sensitization in Hypermobility

How Common Is Central Sensitization in hEDS/HSD?

A 2025 retrospective review in Pain Practice looked at 82 people with hEDS or HSD and screened them using the Central Sensitization Inventory, a validated questionnaire that scores symptoms associated with an oversensitized nervous system on a scale from 0 to 100. Scores in this group ranged from 12 to 94, with a median of 56, and 71 of the 82 patients, 86.5%, met the criteria for central sensitization. That's a large majority, and it's a specific, validated instrument doing the measuring, not a vague clinical impression.

Central sensitization describes a nervous system that has become more reactive over time: it amplifies pain signals, sometimes registers pain from input that wouldn't normally cause it, and does this independent of ongoing tissue damage in any one joint. It helps explain why pain in hEDS/HSD so often doesn't match up neatly with what an X-ray or MRI shows at a given joint on a given day.

Why Exercise Doesn't Reduce Pain the Usual Way in Hypermobility

In most people, moderate exercise triggers something called exercise-induced hypoalgesia, a temporary dampening of pain sensitivity that kicks in during and after physical activity. A 2025 study in the European Journal of Pain compared 37 adolescents with HSD or hEDS to 47 non-hypermobile peers, measuring pressure pain thresholds with an algometer before and after exercise. The hypermobile group showed impaired exercise-induced hypoalgesia: the normal pain-dampening effect that exercise is supposed to produce didn't happen the same way it did in the control group.

That finding matters practically, because it means a common piece of general pain advice, "exercise will help the pain," doesn't play out identically here. It's not that movement is unhelpful; it's that the nervous system response to it seems to work differently in HSD/hEDS, which is exactly the kind of detail worth mentioning to whoever is designing an exercise or physical therapy plan.

Pain Management Approaches Backed by Research

Given a nervous-system-level explanation for widespread pain, the approaches showing up in this area of research aren't joint-specific fixes. They're pain-science education (understanding how central sensitization works, which itself has been shown to change how people experience and respond to pain), graded movement programs that build up activity tolerance gradually rather than pushing through flare-ups, and multidisciplinary pain management that treats the nervous system as part of the problem rather than looking for a single structural cause. None of this is a specific product or purchase. It's a way of framing care that a pain specialist, physical therapist, or multidisciplinary pain clinic would be equipped to build around an individual.