Hypermobility Spectrum Disorders and Medical Cannabis: The Facts
1 in 500
people may have a hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome [1]
Over 98%
of people with hypermobile Ehlers-Danlos syndrome report experiencing chronic pain [2]
What Is Hypermobility Spectrum Disorder?
Hypermobility spectrum disorder (HSD) is a condition where joints move beyond the typical range of motion. This joint flexibility, sometimes called being ‘double-jointed’, is caused by differences in connective tissue, which supports and connects different parts of the body.
While some people with flexible joints experience no problems, others develop symptoms such as joint pain, frequent injuries, and fatigue. When these symptoms affect daily life but do not meet the full criteria for a specific Ehlers-Danlos syndrome diagnosis, the term hypermobility spectrum disorder is used.
HSD and hypermobile Ehlers-Danlos syndrome (hEDS) share many features and are now understood to exist on a spectrum. Both conditions can cause significant symptoms, and the impact on quality of life can be similar regardless of which diagnosis a person receives.
What Is the Difference Between HSD and Ehlers-Danlos Syndrome?
Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders. There are 13 recognised types, each with specific diagnostic criteria. Hypermobile EDS (hEDS) is the most common type and shares many features with HSD.
The main difference lies in diagnosis. A diagnosis of hEDS requires meeting specific criteria set out by international experts in 2017. These criteria include measures of joint hypermobility, additional features affecting the skin and other body systems, and ruling out other conditions.
When someone has symptomatic joint hypermobility but does not meet all the criteria for hEDS, they may receive a diagnosis of HSD. This does not mean their symptoms are less significant. Both conditions can cause chronic pain and affect quality of life in similar ways.
What Causes Hypermobility Spectrum Disorders?
The exact causes of HSD and hEDS are not fully understood. These conditions appear to involve differences in connective tissue, which is found throughout the body in skin, joints, blood vessels, and internal organs.
Many types of Ehlers-Danlos syndrome are caused by changes in genes that affect how the body produces collagen and other proteins. However, the specific genetic cause of hEDS has not yet been identified. Research suggests that both genetic and environmental factors may play a role.
HSD and hEDS often run in families. If a parent has one of these conditions, their children have an increased chance of developing it, though the pattern of inheritance is not always straightforward.
What Causes Ehlers-Danlos Syndromes?
Different types of Ehlers-Danlos syndromes (EDS) are linked to changes in genes that affect how the body produces proteins used in connective tissue. In some cases, the exact gene involved is not yet known.
Most types of EDS are caused by problems with a protein called collagen. More broadly, all types of EDS involve issues with the production of proteins that act as important building blocks of connective tissue.
Some types of EDS, such as hypermobile EDS, can be inherited. Around 50% of children of affected individuals may develop the condition. In other types, the chance of inheriting EDS is lower.
What Are the Different Types of Ehlers-Danlos Syndromes?
There are currently thirteen classified types of EDS. To diagnose a patient with a certain type of EDS, a healthcare professional will match their symptoms to the criteria of each variation to identify the type of EDS that fits.
The majority of the 13 EDS variations are rare; however, the most common types are:
- Hypermobile EDS (hEDS)
Characterised by prominent generalised joint hypermobility. - Classical EDS (cEDS)
Characterised by joint hypermobility, stretchy skin, easy bruising, and abnormal scarring. - Vascular EDS (vEDS)
Due to an abnormal variant in the gene COL3A1, resulting in an increased risk of aneurysms, fistulae and rupture of blood vessels. - Kyphoscoliotic EDS (kEDS)
Associated with severe spinal curvature, unstable joints, and low muscle tone which can make walking difficult.
What Are the Symptoms of Hypermobility Spectrum Disorders and Ehlers-Danlos Syndromes?
People with HSD and hEDS can experience a wide range of symptoms. The most common include:
- Chronic pain in joints, muscles, or throughout the body
- Joints that dislocate or partially dislocate (subluxation) easily
- Fatigue that does not improve with rest
- Soft or stretchy skin that may bruise easily
- Dizziness or feeling faint when standing up (orthostatic intolerance)
- Digestive problems such as bloating, nausea, or reflux
- Poor sleep quality
- Anxiety and low mood
Research suggests these conditions often occur alongside other health issues. A large international survey found that people with hEDS reported an average of 24 different health conditions, highlighting how these disorders can affect multiple body systems [2].
How are Hypermobility Spectrum Disorders and Ehlers-Danlos Syndromes Diagnosed?
Diagnosis of HSD and hEDS usually begins with a detailed medical history and physical examination. A healthcare professional will assess joint flexibility using the Beighton score, which measures hypermobility at specific joints.
For hEDS, the 2017 international diagnostic criteria are used. These consider joint hypermobility alongside other features such as skin involvement, family history, and the presence of related symptoms. When someone does not meet these specific criteria but has symptomatic hypermobility, a diagnosis of HSD may be given.
Reaching a diagnosis can take time. Research indicates that the average time from first symptoms to diagnosis for hEDS is over 22 years [2]. This delay can be frustrating, but getting the right diagnosis helps ensure appropriate care and support.
What Treatment Options Are Available for Hypermobility Spectrum Disorders and Ehlers-Danlos Syndromes?
Like many other chronic pain conditions, there is currently no cure for HSD or hEDS. Treatment focuses on managing symptoms and improving quality of life. A multidisciplinary approach is often recommended, which may include:
Physiotherapy
Physiotherapy is often a cornerstone of management. A physiotherapist experienced in hypermobility can help develop an exercise programme to strengthen muscles around joints, improve stability, and reduce the risk of injury.
Pain Management
Pain relief may include over-the-counter medications, prescribed painkillers, or referral to a specialist pain clinic. Approaches such as pacing activities, heat therapy, and transcutaneous electrical nerve stimulation (TENS) may also help some people.
Psychological Support
Living with chronic pain can affect mental health. Cognitive behavioural therapy (CBT) and other psychological approaches can help people develop coping strategies and manage the emotional impact of their condition.
Occupational Therapy
An occupational therapist can advise on equipment and techniques to make daily activities easier and reduce strain on joints.
When standard treatments do not provide sufficient relief, some people may explore additional options through specialist clinics, which can include medical cannabis.
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How do Hypermobility Spectrum Disorders and Ehlers-Danlos Syndromes Affect Daily Life?
The impact of HSD and hEDS varies from person to person. For some, symptoms may be manageable with lifestyle adjustments. For others, the condition can significantly affect work, relationships, and daily activities.
Chronic pain and fatigue can make it difficult to maintain employment or participate in social activities. Research from the UK Medical Cannabis Registry found that around half of patients with hypermobility-associated chronic pain were not in employment[3].
Sleep problems are common and can worsen other symptoms. Anxiety about unpredictable symptoms, such as joint dislocations, can also affect confidence and independence.
To hear from real patients about their experience with medical cannabis visit our testimonials page.
Medical Cannabis for Ehlers-Danlos Syndromes
For people living with chronic pain associated with HSD or hEDS who have not found adequate relief from conventional treatments, medical cannabis may be an option to explore with a specialist.
Since 2018, specialist clinics in the United Kingdom have been legally permitted to prescribe cannabis-based medicinal products (CBMPs) for certain conditions when other treatments have been tried.
What Does Research Say About Medical Cannabis for Hypermobility Pain?
Research specifically examining medical cannabis for HSD and hEDS is still emerging. Real-world evidence is beginning to be gathered through sources such as the UK Medical Cannabis Registry.
A Registry study examined outcomes in 161 patients with HSD or hEDS who were prescribed medical cannabis for chronic pain. The study collected data on patient-reported outcomes over 18 months [3].
Key observations from this study included:
- Patients reported changes in pain severity and how pain interfered with daily activities
- Changes in sleep quality, anxiety levels, and overall quality of life measures were also assessed.
It is important to understand that this was an observational study without a control group. This means we cannot know whether the reported changes were due to medical cannabis, other factors, or a combination. Many patients did not complete follow-up assessments, which may affect how representative these findings are.
Randomised controlled trials would be needed to determine whether medical cannabis is effective for hypermobility-associated pain. Real-world evidence like this provides insights into patient experiences in routine care but cannot answer questions about effectiveness in the same way clinical trials can.
What Are the Side Effects of Medical Cannabis?
Like all medicines, medical cannabis may be associated with side effects. In the UK Medical Cannabis Registry study of patients with hypermobility-associated pain, about 31% reported experiencing adverse effects [3].
The most commonly reported side effects were:
- Headache
- Fatigue
- Lethargy
- Nausea
- Drowsiness
Most reported effects were rated as mild to moderate in severity. No serious or life-threatening adverse events were recorded in this study. However, individual responses can vary, and any concerns about side effects should be discussed with a prescribing specialist.
Can I be Prescribed Medical Cannabis for Hypermobility Spectrum Disorders and Ehlers-Danlos Syndromes?
Medical cannabis may be considered for people with chronic pain associated with HSD or hEDS when other treatments have not provided sufficient relief or have caused difficult side effects.
In the UK, only doctors listed on the General Medical Council’s Specialist Register are permitted to prescribe medical cannabis. Access through the NHS for chronic pain is very limited, so most prescriptions are issued through private specialist clinics.
If you are exploring whether medical cannabis may be suitable for you, you can complete an initial eligibility assessment with Curaleaf Clinic. We will review your medical and specialist records and, if appropriate, invite you to meet with a consultant experienced in chronic pain to discuss your options.
References
[1] Demmler JC, et al. Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case-control comparison. BMJ Open. 2019. https://doi.org/10.1136/bmjopen-2019-031365
[2] Daylor V, et al. Defining the Chronic Complexities of hEDS and HSD: A Global Survey of Diagnostic Challenges, Life-Long Comorbidities, and Unmet Needs. J Clin Med. 2025. https://doi.org/10.3390/jcm14165636
[3] Dickinson M, Erridge S, Warner‐Levy J, Clarke E, McLachlan K, Coomber R, Holden W, Rucker JJ, Platt MW, Sodergren MH. UK Medical Cannabis Registry: An Analysis of Outcomes of Medical Cannabis Therapy for Hypermobility‐Associated Chronic Pain. ACR Open Rheumatology. 2025 Mar;7(3):e70024.