population. chronic pain has two types. the first type is nociceptive, which is caused by an injury sustained to tissues. the second type is neuropathic pain, caused by abnormal signals by the nervous system. in most cases, the pain is an unequal mix of the two. physiotherapy (exercise rehabilitation) can be helpful, especially stabilizing the core and the joints. stretching exercises must be reduced to slow and gentle stretching to reduce the risks of dislocations or subluxations. usable methods may include posture reeducation, muscle release, joint mobilization, trunk stabilization, and manual therapy for overworked muscles. cognitive behavioural therapy is used in all chronic pain patients, especially those who have severe, chronic, life-controlling pain that is unresponsive to treatment. it had not been checked for efficiency in clinical trials. the state of pain management with eds is considered insufficient. medications nonsteroidal anti-inflammatory drugs (nsaids) may help if the pain is caused by inflammation. but long-term use of nsaids is often a risk factor for gastrointestinal, renal, and blood-related side effects. it can worsen symptoms of mast cell activation syndrome, a disease that may be associated with eds. acetaminophen can be used to avoid the bleeding-related side effects of nsaids. opioids have shown efficiency in some eds cases for the management of both acute and chronic pain. lidocaine can be applied topically after subluxations and painful gums. it can also be injected into painful areas in the case of musculoskeletal pain. if the pain is neuropathic in origin, tricyclic antidepressants in low doses, anticonvulsants, and selective norepinephrine reuptake inhibitors can be used. dislocation and subluxation management when a dislocation or subluxation does occur, muscle spasms and stress tend to occur, increasing pain and reducing the chances of the dislocation/subluxation naturally relieving. methods to support a joint after such an incident include usage of a sling to hold the joint in place and allow it to relax. orthopedic casts are not advised as there could be pain if unrelaxed muscles are still trying to spasm out against the cast. other solutions to promote relaxation are heat, gentle massaging, and mental distractions. surgery the instability of joints, leading to subluxations and joint pain, often requires surgical intervention in people with eds. instability of almost all joints can happen, but appears most often in the lower and upper extremities, with the wrist, fingers, shoulder, knee, hip, and ankle being most common. common surgical procedures are joint debridement, tendon replacements, capsulorrhaphy, and arthroplasty. after surgery, the degree of stabilization, pain reduction, and people's satisfaction can improve, but surgery does not guarantee an optimal result; affected peoples and surgeons report being dissatisfied with the results. the consensus is that conservative treatment is more effective than surgery, particularly since people have extra risks of surgical complications due to the disease. three basic surgical problems arise due to eds – the strength of the tissues is decreased, which makes the tissue less suitable for surgery; the fragility of the blood vessels can cause problems during surgery; and wound healing is often delayed or incomplete. if considering surgical intervention, seeking care from a surgeon with extensive knowledge and experience in treating people with eds and joint hypermobility issues would be prudent. local anesthetics, arterial catheters, and central venous catheters cause a higher risk of bruise formation in people with eds. some people with eds also show a resistance to local anaesthetics. resistance to lidocaine and bupivacaine is not uncommon, and mepivacaine tends to work better in people with eds. special recommendations for anesthesia are given for people with eds. detailed recommendations for anesthesia and perioperative care of people with eds should be used to improve safety. surgery in people with eds requires careful tissue handling and a longer immobilization afterward. prognosis the outcome for individuals with eds depends on the specific type of eds they have. symptoms vary in severity, even in the same disorder, and the frequency of complications varies. some people have negligible symptoms, while others are severely restricted in daily life. extreme joint instability, chronic musculoskeletal pain, degenerative joint disease, frequent injuries, and spinal deformities may limit mobility. severe spinal deformities may affect breathing. in the case of extreme joint instability, dislocations may result from simple tasks such as rolling over in bed or turning a doorknob. secondary conditions such as autonomic dysfunction or cardiovascular problems, occurring in any type, can affect prognosis and quality of life. severe mobility-related disability is seen more often in heds than in classical eds or vascular eds. although all types of eds are potentially life-threatening, most people have a normal lifespan. those with blood vessel fragility, though, have a high risk of fatal complications, including spontaneous arterial rupture, which is the most common cause of sudden death. the median life expectancy in the population with vascular eds is 48 years. vascular pseudoaneurysm vascular lesions (nature is disputed) due to tears in the lining of the arteries or deterioration of congenitally thin and fragile tissue enlarged arteries gastrointestinal a 50% risk of colonic perforation exists in vascular ehlers danlos syndrome. obstetric pregnancy increases the likelihood of uterine rupture. maternal mortality is around 12%. uterine hemorrhage can occur during the postpartum recovery. epidemiology ehlers–danlos syndromes are estimated to occur in about one in 5,000 births worldwide. initially, prevalence estimates ranged from one in 250,000 to 500,000 people, but these were soon found to be low, as medical professionals became more adept at diagnosis. eds may be far more common than the currently accepted estimate due to the wide range of severities with which the disorder presents. the prevalence of the disorders differs dramatically. the most common is hypermobile eds, followed by classical eds. the others are very rare. for example, fewer than 10 infants and children with dermatosparaxis eds have been described worldwide. some types of eds are more common in ashkenazi jews. for example, the chance of being a carrier for dermatosparaxis eds is one in 2,000 in the general population but one in 248 among ashkenazi jews. history until 1997, the classification system for eds included 10 specific types and acknowledged that other extremely rare types existed. at this time, the classification system underwent an overhaul and was reduced to six major types using descriptive titles. genetic specialists recognize that other types of this condition exist, but have only been documented in single families. except for hypermobility (type 3), the most common type of all 10 types, some of the specific variations involved have been identified, and they can be precisely identified by genetic testing; this is valuable due to a great deal of variation in individual cases. negative genetic test results, though, do not rule out the diagnosis, since not all of the variations have been discovered; therefore, the clinical presentation is very important. forms of eds in this category may present with soft, mildly stretchable skin, shortened bones, chronic diarrhea, joint hypermobility and dislocation, bladder rupture, or poor wound healing. inheritance patterns in this group include x-linked recessive, autosomal dominant, and autosomal recessive. examples of types of related syndromes other than those above reported in the medical literature include: 305200: type 5 130080: type 8 – unspecified gene, locus 12p13 225310: type 10 – unspecified gene, locus 2q34 608763: beasley–cohen type 130070: progeroid form – b4galt7 130090: type unspecified 601776: d4st1-deficient ehlers–danlos syndrome (adducted thumb-clubfoot syndrome) chst14 society and culture eds may have contributed to the virtuoso violinist niccolò paganini's skill, as he was able to play wider fingerings than a typical violinist. many sideshow performers have eds. several of them were billed as the elastic skin man, the india rubber man, and frog boy. they included such well-known individuals (in their time) as felix wehrle, james morris, and avery childs. two performers with eds currently hold world records. contortionist daniel browning smith has hypermobile eds and holds the current guinness world record for the most flexible man as of 2018, while gary "stretch" turner, sideshow performer in the circus of horrors, has held the current guinness world record for the most elastic skin since 1999, for his ability to stretch the skin on his stomach 6.25 inches. notable cases stevie boebi and annie elainey, who have eds, standing with mobility aids on the red carpet pageant contestant victoria graham has eds. actress cherylee houston has hypermobile eds. she uses a wheelchair and was the first full-time disabled actress on coronation street drag queen and winner of the 11th season of rupaul's drag race yvie oddly eric the actor, a regular caller to the howard stern show actress and activist jameela jamil writer and actress lena dunham australian singer sia singer halsey youtuber and disability rights activist annie elainey miss america 2020 camille schrier deaf singer/songwriter mandy harvey singer-songwriter, author and artist martha marlow pornographic actress and writer lorelei lee reality show contestant trevor jones, dead from the vascular form of the disorder scrunchie creator rommy hunt revson, dead from a ruptured aorta japanese voice actress and singer tomori kusunoki other species ehlers–danlos-like syndromes have been shown to be hereditary in himalayan cats, some domestic shorthair cats, and certain breeds of cattle. it is seen as a sporadic condition in domestic dogs. it has a similar treatment and prognosis. animals with the condition should not be bred, as the condition can be inherited. animal eds eds in a dog same dog with eds eds in the same dog showing an atrophic scar degenerative suspensory ligament desmitis is a similar condition seen in many breeds of horses. it was originally notated in the peruvian paso and thought to be a condition of overwork and older age, but it is being recognized in all age groups and all activity levels. it has been noted in newborn foals.