Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights

Abstract

Ashley N Junghans-Rutelonis,1 Andrea Postier,1,2 Andrew Warmuth,1,3 Scott Schwantes,1 Karen E Weiss4 1Department of Pain Medicine, Palliative Care, and Integrative Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA; 2Children’s Minnesota Research Institute, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA; 3Department of Physical Medicine and Rehabilitation, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA; 4Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine & Seattle Children’s Hospital, Seattle, DC, USACorrespondence: Ashley N Junghans-RutelonisDepartment of Pain Medicine, Palliative Care, and Integrative Medicine, Children’s Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55304, USATel [phone]Fax [phone]Email [email protected]: Pediatric patients with postural orthostatic tachycardia syndrome (POTS) often present with co-occurring struggles with chronic pain (POTS+pain) that may limit daily activities. POTS is a clinical syndrome characterized by orthostatic symptoms and excessive postural tachycardia without orthostatic hypotension. Active research from the medical and scientific community has led to controversy over POTS diagnosis and treatment, yet patients continue to present with symptoms associated with POTS+pain, making treatment recommendations critical. This topical review examines the literature on diagnosing and treating pediatric POTS+pain and the challenges clinicians face. Most importantly, clinicians must employ an interdisciplinary team approach to determine the ideal combination of pharmacologic (e.g., fludrocortisone), non-pharmacologic (e.g., physical therapy, integrative medicine), and psychological (e.g., cognitive behavioral therapy, psychoeducation) treatment approaches that acknowledge the complexity of the child’s condition, while simultaneously tailoring these approaches to the child’s personal needs. We provide recommendations for treatment for youth with POTS+pain based on the current literature.Keywords: youth, pediatric, postural orthostatic tachycardia syndrome, chronic pain, treatment

Keywords

• youth
• pediatric
• postural orthostatic tachycardia syndrome
• chronic pain
• treatment