Local treatment of pain

They should be preferred over general acting medications.

 

Physical agents

 

They are particularly effective here because of the thinness of the skin which they easily penetrate to act in depth.

The most effective is the transcutaneous electrical stimulator or TENS (Trans Electro Neuro Stimulation).

It works according to the gate theory: a sensory impulse stops painful impulses coming from the same neurological territory at the spinal cord level.

The devices on the market deliver low frequency currents at 80 or 100 HZ or cycles/sec which are the most effective in the Ehlers-Danlos Syndrome.

They can be used on all parts of the body (including the abdomen and the facial-mandibular region) with a restriction for the cardiac area if the patient has an implanted pacemaker.

The device is equipped with two sets of self-adhesive electrodes that allow two simultaneous applications but in close proximity to each other.

The intensity of the current is adjusted until the person feels a sensation that should not be painful.

An adjustment may be necessary depending on, for example, perspiration.

The duration of use is unlimited, it can be at night.

The ability to carry the battery attached to the belt or in a pocket makes it easy to use on a daily basis.

Reactions to the adhesive of which there is a better tolerated allergen-free version can be observed.

Very rarely, this treatment exacerbates the pain, sometimes by a short circuit between the electrodes, due to heavy sweating.

The limit of this treatment is the disappearance of analgesic effects when its application is stopped.

 

 

Ultrasound

 

They are applied by a physiotherapist, and are indicated in tendinitis.

 

The heat

 

In various forms (hot baths, application of hot compresses or hotpacs), it has an analgesic effect by TENS and relaxing effect.

Climatic factors should also be stressed: a stay in a region with a hot and dry climate is very often accompanied by a significant improvement.

 

The cold

 

Classical medication in local anti-inflammatory treatments, it is most often poorly tolerated but the few attempts at generalized cryotherapy at very low temperatures that we have learned about encourage the use of this therapeutic avenue in the future.

 

Thermal cures

 

Their effects are similar to those of treatment with physical agents.

By combining the thermal effects of contact with water using various types of body stimulation, a lasting improvement in all symptoms was observed in groups of patients undergoing a cure in the same resort (Le Mont-Dore), lasting several months after three weeks of treatment.

In this case, it is combined with treatments concerning the respiratory system, which has an important role in the pathophysiology of Ehlers-Danlos syndrome.

These effects will be found in the application of hydro-balneotherapy.
It is therefore coherent to introduce in the therapeutic management of these patients thermal cures, preferably in hot climatic regions, combining joint and muscular effects with respiratory and, if possible, gastrointestinal effects.

 

Repeated multiple local, subcutaneous, or intramuscular injections of Lidocaine 5 mg per ml.

 

This technique, initiated by Dr. Gilles Mazaltarine, has been refined and widely disseminated to a growing number of patients in the face of increasing positive results.

The principle is to act where the pain is and where it starts: muscular " trigger zones ", tendons, muscle insertions, intercostal muscles.

Contrary to what is observed in the gums or nerve roots, Lidocaine is not only effective, but also long-lasting (up to one year, we have observed).

Multiplying the number of injection sites (5 to 15) in a single session seems to result in a beneficial regional spread of effects.

These results are obtained for minimal doses (a few ml), allowing several injections to be made in a single session without exceeding a total of 10 ml for one session.

Exaggerated pain after the injections is exceptional.

On the other hand, cutaneous hypersensitivity can be very violent and constitute an insurmountable obstacle.

In this case, the solution is to apply a Lidocaine(Emla) poultice half an hour before the injections, in the areas identified by palpation.

A sheet detailing the protocol is attached to this site.

By comparing the results obtained with local injections of Lidocaine, we believe that this is the most effective method of treating Ehlers-Danlos syndrome pain, with the fewest side effects.

 

General pain medication

 

The pain of Ehlers-Danlos syndrome is often resistant to analgesics commonly used in other etiologies, but the side effects are often significant.

A long practice and exchanges with other doctors treating Ehlers-Danlos syndrome have led us, today, to a number of proposals that seem to suit a majority of patients (not all and not all at all times).

First of all, certain widely used analgesic medications should be avoided: class 1 morphine drugs (because of their side effects, the risk of addiction and the accentuation, in the long term, of pain).

An exception is Tramadol, which is a class 2 synthetic morphine, provided it is used for short periods to avoid addiction. Antiepileptics and antidepressants have side effects and uncertain efficacy.

We mainly offer 4 drugs.

Two as a background treatment for their action on muscular pain: Baclofen and L-Carnitine(this molecule also has a defatizing and transit-accelerating effect, which can improve constipation).

The other two are seizure medications: Tramadol in LP form for " moderate pain " and Acupan for particularly severe seizures.

Other analgesics can be effective: anti-inflammatory drugs provided you use a gastric bandage or take a proton pump inhibitor.

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