Click Here to Download this Blog Post – The “Why” Behind The Pain (Part 13)
By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.
Many people spend years—sometimes decades—bouncing between doctors, trying to explain two persistent problems: constant dizziness and chronic pain.
If you have been diagnosed with hEDS (Hypermobile Ehlers-Danlos Syndrome) or HSD (Hypermobility Spectrum Disorder), these aren’t just random bad luck. There is a specific chain of command causing your symptoms, and understanding it is the first step to managing it.
The Chain Reaction: From Tissue to Nerves to Pain
It is helpful to think of your condition as a domino effect. Here is how the medical literature explains the sequence:
- The Root Cause: You have hEDS or HSD. This means your connective tissue (the glue holding your body together) is built differently.
- The Middleman: Because your tissue is “stretchy” or loose, it interferes with your P&S (Parasympathetic and Sympathetic) Nerves. As we discussed in the previous post, this causes your body’s “autopilot” to glitch.
- The Symptom: This nerve dysfunction leads to Orthostatic Dysfunction (dizziness and fainting when standing). Crucially, these nerve glitches also amplify pain. The pain isn’t just in your joints; your nervous system is turning the volume knob up, making everything hurt more.
What Doctors Should See: The Physical Clues
When a doctor looks at your history and performs a physical exam, they shouldn’t just be looking at your heart rate. They should be looking at you.
In patients with these disorders, the body tells a story through four main physical signs:
- Super-Stretchy Skin (Hyperextensibility): Your skin might pull away from your body much further than the average person’s, almost like elastic.
- Over-Flexible Joints (Hypermobility): You can bend your fingers, elbows, or knees past the “normal” stopping point.
- Fragile Tissue: Your skin might tear easily or heal poorly.
- Easy Bruising: You might find mysterious bruises without remembering how you got them, because the blood vessels under the skin are fragile.
A Critical Warning: The “Vascular” Variety
While hEDS is the most common form, there is a rarer, more dangerous cousin called Vascular EDS (vEDS).
The medical community often misses this diagnosis until it is too late—usually after a major, life-threatening event. Because vEDS affects the blood vessels and organs directly, it requires different attention.
The Red Flags for Vascular EDS If you or a family member have a history of the following, especially if it happened before age 40, it is vital to check for vEDS:
- Organ Rupture: A history of intestines or other organs tearing or rupturing unexpectedly.
- Aneurysms: Bulges in blood vessels.
- Major Bleeding: Bleeding that is difficult to stop or happens spontaneously.
The Takeaway: If you have easy bruising combined with a family history of sudden organ trouble or aneurysms at a young age, do not wait. This specific history is the loudest alarm bell for doctors to investigate Vascular EDS immediately.
Where to Seek Expert Care?
It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034
About the Author
Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.
Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.
In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.
👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace