R2. POTS and Central Sensitization: Meeting Patients' Needs in a New Clinic

Postural Orthostatic Tachycardia Syndrome (POTS) is a syndrome becoming more prevalent in clinical practice, often leaving primary physicians and specialty clinics at a loss on how to diagnose and manage this challenging population. Prevalent complaints often focus on lightheadedness upon position change, dizziness, sometimes with syncopal episodes and a significant decline in physical conditioning. Additional symptoms can include fatigue, palpitations, headaches, abdominal and chest pain, widespread pain and perception of cognitive changes. Onset of this syndrome most often occurs in adolescents and young adults, frequently having a significant impact on every day functioning and overall quality of life. This downward spiral can sometimes lead to a “failure to launch” phenomenon. POTS is diagnosed after a number of autonomic tests are performed and other causations are ruled out. Our recent clinical experience has revealed a consistent overlap of patients who experience symptoms of both POTS and central sensitization, providing intriguing evidence for future study. Some overlapping symptoms include positive fibromyalgia tender points on a considerable number of patients, headaches, sleep concerns, fatigue and numerous gastrointestinal complaints. This poster will provide an overview of a POTS clinic established to address concerns presented by patients age 18-28. Standard diagnostic tests include over 20 labs, 24 hour urine, ECG, thermoregulatory sweat test, autonomic reflex screen, chest x-ray, 24 hour BP with Holter monitor, Transthoracic-Echocardiogram, and cardiopulmonary exercise. Additional testing is often added on an individual need basis. Also included in the clinic is 1:1 education on POTS and stress management, Integrative Medicine (acupuncture and biofeedback, occasional massage therapy, sleep education and mindfulness). Patients and their families are educated about the importance of rehabilitative services and often participate in an extended three week rehabilitative program to improve their overall functioning and quality of life.