Yes, uncomplicated POTS patients can experience pain. Many POTS patients suffer with an assortment of pains. The most frequent pain recognized is headache. Additionally, more than half of POTS patients endure some kind of abdominal pain and less than half experience chest pains.
The majority of POTS subjects report having headaches. They take on a variety of forms. Most often the headaches occur during standing and frequently are preceded by dizziness. Headaches may be localized (behind the eyes or back of head), or migraine-like (associated with nausea, dizziness and vomiting). Headaches may occur daily or irregularly. For most the headaches and associated symptoms occur early in the day, for others they are worse as the day progresses. Lying down or going back to bed often relieves most POTS-related headaches.
Those challenged with a frustrating and poorly treated illness like POTS can suddenly become anxious and stressed-out. Emotional stress sets off involuntary brainstem signals that tighten one’s muscles – all part of the “fight or flight” preparation for battle reaction. This generalized muscle tightening includes tensing of the diaphragms (muscles that move air in and out of the lungs). During normal abdominal breathing the diaphragm muscles (one on each side) contract downward drawing air in to fill the lungs. Tensing (locking the diaphragms in the down position) forces one to utilize the muscles of the rib cage to lift the ribs and draw air into the lungs. Whereas chest breathing is less efficient than diaphragmatic breathing, chest breathing requires faster shallow breathing. This rapid shallow chest breathing is known as hyperventilation. Unlike calm abdominal breathing, rapid chest breathing associated with stress puts strain on the 48 joints of the rib cage resulting in characteristic rib cage pain. The most common chest pain experienced by POTS patients is rib cage pain, localized to the rib cage joints and is associated with tenderness of the effected joints (costochondritis). Whereas many POTS patients are overly stressed, hyperventilation, pain and tenderness of the joints of the rib cage are common. My book POWER over POTS provides Tips for Learning Healthy Breathing and overcoming hyperventilation.
Many POTS patients report experiencing abdominal pain, described as nausea, cramping, bloating and pain. These symptoms occur most frequently with standing and/or following a large meal. With both standing and large meals, a large volume of blood shifts from the chest towards the lower body. How this volume shift disrupts normal intestinal motility (movement of intestinal contents) is unclear. Among some POTS patients, the symptoms can be quite severe and debilitating. Thus, many POTS patients prefer to recline instead of standing and/or avoid eating so as to minimize their abdominal discomfort. If untreated, ultimately avoiding eating can result in weight loss.
Those patients with medical conditions that frequently co-exist with POTS experience pain in additional body organs. Those with POTS and Ehlers-Danlos Syndrome (EDS) are prone to recurrent sprains, dislocations, chronic arthritis and joint pains. Those with POTS and Chiari malformation suffer with neck pain In addition to headaches. Those with POTS and Celiac Artery Compression Syndrome suffer with right-sided upper abdominal pain primarily following a large meal. Those with POTS and Mast Cell Activation Disorder (MCAD) can have painful head, chest, muscles, bones and joints. POWER over POTS describes these conditions in greater detail.