Disclosures: Bo Song, MD: No disclosure data submitted.

Objective: To examine the commonly prescribed treatments for Ehlers Danlos Syndrome (EDS) and their efficacies.

Design: Retrospective Chart Review

Setting: Academic Outpatient Clinic

Participants: 27 patients (26 female, 1 male) ages 19-63 were evaluated in pain/musculoskeletal clinic between 1/1/2018 and 2/28/2019.

Interventions: Patients underwent a variety of treatments including non-steroidal anti-inflammatory drugs (NSAIDS), bracing/orthotics, physical therapy (PT), corticosteroid injections, neuropathic pain modulators, muscle relaxants, opiates, and conservative treatments.

Main Outcome Measures: Subjective pain measures were grouped into 3 categories: improvement, no improvement, and worsening symptoms.

Results: 80% of patients prescribed bracing/orthotics reported improvement. NSAIDS/acetaminophen were prescribed to 17 patients with 35.3% reporting relief. 44.4% of patients prescribed opiates had improvement, however 16.7% had adverse effects. Of the opiates, acetaminophen/hydrocodone (Norco) appeared to be most effective with 71.4% responding favorably. Other modalities reporting some improvement included corticosteroid injections (63.6%), muscle relaxants such as tizanidine or cyclobenzaprine (50%), and chiropractic or acupuncture treatments (16%). 100% of patients on neuropathic pain modulators such as gabapentin or pregabalin reported no improvement. Overall, all patients were counseled about their condition and prescribed PT, of which 25% reported improvement, 50% with no improvement, and 25% with worsening symptoms. 9 patients were lost to follow up.

Conclusions: EDS patients often present with a multitude of musculoskeletal symptoms that can be difficult to manage. These patients are generally counseled extensively and prescribed PT with mixed results. The most effective treatments seen in this study were bracing and orthotics. Other commonly used interventions such as corticosteroid injections, NSAIDS and acetaminophen, muscle relaxants, and opiates have shown moderate benefit, with different medications in each class offering varying effects. Neuropathic pain modulators and chiropractic/acupuncture seem to be less effective at treating EDS pain. EDS pain is complex and multiple different treatment modalities may need to be attempted before adequate relief.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/effectiveness-of-different-therapeutic-modalities-on-pain-relief-in-patients-with-ehlers-danlos-syndrome/