343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2197016

Twists and Triggers: Multimodal Pain Control in Stiff Person Syndrome and Ehlers-Danlos with Chronic Testicular Pain

View Poster Contact Presenter

Poster Presenter

Renira Rugnath

Authors

Renira Rugnath

Affiliations

The University of Mississippi Medical Center, Department of Anesthesiology

Part of Topic

Medically Challenging Cases

Introduction

•Stiff Person Syndrome (SPS) is a rare autoimmune disorder characterized by muscle rigidity, painful spasms, and heightened CNS excitability, often associated with anti-GAD antibodies [1,2,6,7].

•Ehlers-Danlos Syndrome (EDS) involves connective tissue fragility, joint hypermobility, and chronic musculoskeletal pain, resulting from abnormal collagen synthesis.

•The coexistence of SPS and EDS creates a unique pain phenotype—a combination of neuromuscular rigidity and connective tissue instability that complicates diagnosis and management.

•Conventional SPS therapies such as benzodiazepines, baclofen, and IVIG can improve stiffness and function but may not adequately control chronic pain or emotional distress [1–7].

•IVIG has demonstrated benefit in reducing muscle spasms and improving quality of life in SPS patients [1,4,7].

•Ketamine infusions, acting via NMDA receptor antagonism, have shown efficacy in refractory neuropathic and central sensitization-related pain [8–10].

•Psychological comorbidities—anxiety, depression, and psychosocial stressors—can further amplify pain perception, emphasizing the need for biopsychosocial integration in treatment.

•This case highlights the synergistic benefit of combining immunotherapy (IVIG), ketamine infusions, and cognitive behavioral therapy (CBT) for refractory pain in a patient with both SPS and EDS.

Case Report

34-year-old male with a history of Stiff Person Syndrome (SPS) confirmed by anti-GAD antibodies and EMG, and Ehlers-Danlos Syndrome (EDS) diagnosed by clinical features.
Presented to Interventional Pain Management clinic (May 2020) for chronic testicular pain persisting after orchiectomy.
Prior interventions included:
- Iliohypogastric and spermatic cord nerve blocks
- Intravenous lidocaine infusions
- IVIG therapy for SPS
- PRN benzodiazepines and opioids for symptom control
Despite multiple treatments, the patient reported minimal and transient pain relief, with progressive decline in functional status.
Increasing anxiety, marital stress, and emotional distress further exacerbated his pain experience and coping ability.
A multidisciplinary treatment plan was initiated, integrating:
- Ongoing IVIG infusions for immune modulation
- Ketamine infusions targeting refractory neuropathic and central sensitization pain
- Cognitive Behavioral Therapy (CBT) to address psychological and coping factors
Collaborative management involved Pain Medicine, Psychiatry, and Psychology services.
After three months of combined therapy, the patient reported:
- Significant improvement in pain intensity and reduction in spasm frequency
- Improved mood, coping skills, and overall functional capacity
- Enhanced quality of life with greater independence in daily activities