Youth with Chronic Pain and Postural Orthostatic Tachycardia Syndrome (POTS): Treatment Mediators of Improvement in Functional Disability

Abstract

Intensive pain rehabilitation programs are effective in increasing functioning for youth with chronic pain (CP). However, the utility of such programs for youth with CP and co-morbid postural orthostatic tachycardia syndrome (POTS) is rarely examined. In addition, studies examining mediators of treatment for CP are sparse. This paper compares treatment outcomes for youth with CP (n = 117) and youth with CP + POTS (n = 118). Additionally, depression and pain catastrophizing were tested as potential mediators of treatment effects. Significant treatment improvements were found for functional disability, depression, pain catastrophizing, and perceived pain intensity but with no differences between groups. Improvements in depressed mood, pain catastrophizing (helplessness subscale), and pain severity partially mediated functioning improvement. Pain severity was not a significant mediator in the CP + POTS group. We concluded that depression and pain catastrophizing, especially the helplessness domain, can impact functioning improvement in adolescents with CP and POTS and are particularly important to target in treatment.

Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome

“…Chronic opioid use may exacerbate symptoms, particularly in patients with POTS who have existing GI dysmotility, and create dependence. Pain management programs have been shown to increase functioning and quality of life by reducing catastrophizing and managing associated depression . Given the complexity of problems present in patients with POTS, a multidisciplinary management approach involving specialists in neurology, gastroenterology, nutrition, psychiatry, and pain management as necessary is important.…”

<p>Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights</p>

“…However, the levels of functional disability across these groups are unclear. While Keating and colleagues (2016)60 found similar levels of functional disability between youth with POTS+pain and pain alone, Junghans-Rutelonis and colleagues (2018)59 found greater functional disability among youth with POTS+pain at the beginning of an intensive rehabilitation program. Parental protective behavior, pain catastrophizing, and attributions of pain to physical causes have been associated with decreased youth functional ability in both groups and parents are now being included in research examining the benefits of parental involvement in treatment programs 60–63…”

“…Literature highlighting psychological adjustment and cognitive functioning among youth with POTS+pain remains scarce but authors describe similar clinical presentations and levels of depression, anxiety, and pain catstrophizing among youth with POTS+pain and pain alone 1,59,60. However, the levels of functional disability across these groups are unclear.…”

“…CBT and ACT may help youth with POTS+pain as well. Given that youth with POTS often experience catastrophic thoughts that affect their functioning,59 therapies that focus on increasing functioning within the context of these types of thoughts can be helpful in decreasing the power that those thoughts have over one’s behavior. In one study, increase in acceptance of pain was related to increased overall functioning 73…”

“…For patients who experience moderate to severe debilitation due to POTS+pain or who are unable to otherwise access adequate treatment, participation in an intensive interdisciplinary pain rehabilitation program (IIPRP) has been shown effective in increasing functioning and improving psychological distress from baseline to follow-up among youth with POTS21 and youth with pain 74–79. Interdisciplinary evaluation and treatment are considered to be the most efficacious, cost-effective, and evidence-based treatment approaches to chronic pain and have shown preliminary effectiveness for youth with POTS+pain 21,59,80,81. Interdisciplinary teams discussed in the literature include health-care providers from the following disciplines: anesthesiology, nursing, occupational therapy, physical therapy, psychology, social work and recreational therapy 82.…”