#18 Linda Bluestein, M.D.: Hypermobility, Ehler-Danlos Syndromes and chronic pain: classification, diagnosis, pain sensitization, and treatment options with a focus on uncommon pharmacy options

Dr Linda Bluestein, is a board-certified anesthesiologist and integrative medicine physician with a focus on hypermobility, Ehler-Danlos Syndromes and complex patients with chronic pain. In this brilliant exposition, she defines hypermobility, lays out the esoteric classifications of hypermobile Ehler Danlos Syndrome vs Hypermobility Spectrum Disorders and why naming matters for assessment and treatment of symptoms. Dr Bluestein then dives into practical recommendations for thinking about how connective tissue dysfunction (it's said "If you can’t connect the issues, think connective tissues”) can impact a variety of systems like the gut (constipation, prolapse, reflux, distention, gastroparesis), skin (delayed wound healing, poor scarification), dysautonomia, mast cell activation syndrome, in addition to the typical musculoskeletal conditions of dislocations, subluxations and other joint injuries. She notes, so wisely, that if we can shorten the typical diagnosis from ~25 years to, pretty much anything shorter than that, we can prevent a tremendous amount of chronic pain later in life. And then Dr Bluestein teases apart types of pain: nociceptive (meaning direct injury to tissues like from an injury), neuropathic pain (meaning dysfunction of the nerves themselves) or nociplastic pain (meaning dysfunction in how we process sensation) and the eventual progression to central sensitization syndromes, like fibromyalgia, if pain is allowed to linger. Finally, we cap off with a discussion about some selective pharmaceuticals, some common and some uncommon, and how to think about them: opioids, benzodiazepines, muscle relaxants, oxytocin, NMDA antagonists (magnesium, ketamine, memantine). 

Find out more: 

• http://www.hypermobilitymd.com/
• Book: Disjointed | Navigating the Diagnosis and Management of hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders which can be ordered here: https://www.amazon.com/Disjointed-Navigating-hypermobile-Ehlers-Danlos-Hypermobility/dp/1734794909/ref=pd_lpo_14_t_0/136-4762933-2366558?_encoding=UTF8&pd_rd_i=1734794909&pd_rd_r=acaa36c6-0aac-47c7-a2f3-4bd1b7ba15d7&pd_rd_w=fy7Ld&pd_rd_wg=HsWpW&pf_rd_p=7b36d496-f366-4631-94d3-61b87b52511b&pf_rd_r=RC3MY8A7KJ999FZDE4JY&psc=1&refRID=RC3MY8A7KJ999FZDE4JY