Coat Hanger Pain: Understanding Its Connection with POTS and Ehlers Danlos Sydnrome

Introduction

Coat hanger pain, a unique and often misunderstood symptom, is predominantly associated with Postural Orthostatic Tachycardia Syndrome (POTS) and other forms of dysautonomia.   Characterized by discomfort in the neck, particularly the suboccipital and paracervical regions, this condition draws its name from the distinct pattern of pain resembling the shape of a coat hanger. This article aims to unravel the complexities surrounding coat hanger pain, shedding light on its causes, symptoms, and its intricate relationship with autonomic dysfunctions.

What is Coat Hanger Pain?

The name 'coat hanger' pain originates from the pattern of discomfort that mirrors the shape of a coat hanger, spanning the neck and shoulder area. This peculiar type of pain is predominantly found in individuals with POTS and dysautonomia. Researchers have observed that an astonishing 93% of patients with autonomic dysfunction and 51% of those with multiple system atrophy experience this condition.

Why Does It Occur?

Although the exact cause of coat hanger pain remains unclear, a prevailing theory suggests hypoperfusion - a reduced blood flow - in crucial neck muscles as a potential cause. This lack of adequate blood flow can lead to muscle cramps and discomfort, especially in postures where the head is elevated, like sitting or standing. Interestingly, lying down often provides temporary relief, highlighting the pain's unique relationship to body posture.

Understanding the Pain

Coat hanger pain is often characterized by a cramping sensation, believed to result from the reduced blood flow to the neck muscles. These muscles are constantly in use (termed 'tonically active'), necessitating a continuous supply of oxygenated blood. In conditions like POTS, where blood flow is compromised, these muscles may not receive enough oxygen, leading to the accumulation of lactic acid and subsequent cramping.

Distinguishing Coat Hanger Pain

One of the key aspects distinguishing coat hanger pain from similar symptoms related to Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder (EDS/HSD) is its response to posture. While other conditions might cause persistent neck pain, coat hanger pain typically eases when the patient lies down, providing a critical clue for accurate diagnosis.

Conclusion

Coat hanger pain, often an "invisible" symptom of dysautonomia and POTS, requires more awareness and understanding. Its unique characteristics, particularly its connection with posture and the theory of reduced blood flow, are essential for effective diagnosis and treatment. As research continues, a deeper understanding of this condition will emerge, leading to better management and improved quality of life for those affected.

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Sources:

1. Cariga, P, et al. “The Prevalence and Association of Neck (Coat-Hanger) Pain and Orthostatic (Postural) Hypotension in Human Spinal Cord Injury.” Nature News, Nature Publishing Group, 8 Feb. 2002, www.nature.com/articles/3101259.
2. Simmons, Amy. “Coat Hanger Phenomenon & the Pretzel Leg Sign.” The Dysautonomia Project, 17 July 2023, thedysautonomiaproject.org/coat-hanger-phenomenon-the-pretzel-leg-sign/.