Are POTS and Fibromyalgia Linked?

Postural orthostatic tachycardia syndrome (POTS) and fibromyalgia often coexist in patients. Both share overlapping symptoms, associations, and potential underlying mechanisms which makes it important for both patients and doctors to understand these conditions

This article discusses the relationship between POTS and fibromyalgia, symptoms of both conditions, how they are diagnosed, treatment options, and answers to frequently asked questions about these conditions.

The Link Between POTS and Fibromyalgia

POTS is a form of dysautonomia that causes a rapid heart rate and lightheadedness when standing. Fibromyalgia, on the other hand, is characterized by widespread pain and heightened sensitivity to stimuli. While these conditions may seem unrelated, research suggests they share several characteristics and associations.

1. Neurological Basis
   POTS has traditionally been viewed as a disorder of the peripheral nervous system, though emerging evidence points to central nervous system (CNS) involvement. Similarly, fibromyalgia is increasingly understood as a CNS hypersensitivity condition.
2. Overlap of Symptoms
   Both POTS and fibromyalgia patients report symptoms like fatigue, headaches, and cognitive difficulties. Studies have found higher rates of orthostatic intolerance in fibromyalgia patients, suggesting a potential shared pathophysiology.
3. Connection to Joint Hypermobility and Connective Tissue Disorders
   Many individuals with POTS and fibromyalgia also exhibit joint hypermobility or have conditions such as Ehlers-Danlos syndrome (EDS). This further reinforces the link between these disorders.
4. COVID-19 Link
   Both POTS and fibromyalgia have been associated with post-viral syndromes, including long COVID. Research indicates autoimmunity and inflammatory mechanisms may contribute to the onset of these conditions after viral infections.

Symptoms of Fibromyalgia and POTS

Symptoms of POTS

POTS symptoms can be grouped into three main categories:

• Orthostatic Symptoms: Rapid heart rate, dizziness, fainting, chest pain, and lightheadedness when standing.
• Cerebral Symptoms: Fatigue, brain fog, migraines, and blurred vision.
• Other Symptoms: Nausea, abdominal discomfort, insomnia, muscle pain, and temperature sensitivity.

Symptoms of Fibromyalgia

Fibromyalgia affects more than just the perception of pain. Symptoms include:

• Widespread pain and tender points.
• Chronic fatigue.
• Cognitive challenges ("fibro fog").
• Sensitivity to light, sound, and temperature.
• Sleep disturbances.
• Co-occurring conditions like irritable bowel syndrome (IBS).

Overlapping Symptoms of POTS and Fibromyalgia

1. Fatigue

• POTS Patients: Fatigue is debilitating and closely tied to physical activity or prolonged standing.
• Fibromyalgia Patients: Chronic, pervasive fatigue persists despite rest and is often associated with non-restorative sleep.

2. Brain Fog (Cognitive Challenges)

• POTS Patients: Often described as mental haze or lightheaded confusion, especially after standing or during flare-ups.
• Fibromyalgia Patients: Persistent cognitive difficulties, including trouble focusing, recalling information, or thinking clearly.

3. Pain and Tenderness

• POTS Patients: Intermittent muscle aches, particularly after orthostatic stress or prolonged activity.
• Fibromyalgia Patients: Widespread and constant pain, often with specific tender points highly sensitive to touch.

4. Temperature Sensitivity

• POTS Patients: Sensitivity to heat can lead to dizziness, sweating, or fainting; cold sensitivity may also affect circulation.
• Fibromyalgia Patients: Both heat and cold sensitivity, with discomfort often described as burning or sharp.

5. Sleep Disturbances

• POTS Patients: Insomnia or fragmented sleep due to tachycardia or night sweats; waking up feeling unrefreshed.
• Fibromyalgia Patients: Non-restorative sleep leaves patients exhausted and stiff despite sleeping through the night.

6. Gastrointestinal Symptoms

• POTS Patients: Nausea, abdominal discomfort, diarrhea, or constipation linked to blood pooling or autonomic dysfunction.
• Fibromyalgia Patients: IBS-like symptoms such as alternating constipation and diarrhea, often accompanied by bloating.

7. Lightheadedness and Dizziness

• POTS Patients: Lightheadedness upon standing, often with visual disturbances or near-syncope.
• Fibromyalgia Patients: Occasional dizziness during episodes of fatigue or sensory overload.

8. Sensitivity to Sensory Stimuli

• POTS Patients: Sensitivity to light and sound during flare-ups, often associated with migraines or overstimulation.
• Fibromyalgia Patients: Heightened sensitivity to light, sound, and touch, often described as overwhelming or painful.

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Diagnosing POTS and Fibromyalgia

• POTS: Diagnosis involves tests such as the tilt table test, blood pressure monitoring, and evaluation for autoimmune markers like anti-gAChR antibodies.
• Fibromyalgia: Fibromyalgia is a diagnosis of exclusion, relying on patient history and the presence of widespread pain for at least three months.

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Treatment for Fibromyalgia and POTS

Fibromyalgia Treatment

Fibromyalgia treatment focuses on managing symptoms and improving quality of life. While there is no cure, various approaches can reduce symptom severity:

1. Medications
   • Antidepressants: Medications like duloxetine and amitriptyline help modulate pain perception.
   • Anti-seizure Medications: Gabapentin and pregabalin are often prescribed for nerve pain.
   • Pain Relievers: Over-the-counter or prescription analgesics may alleviate localized pain.
2. Lifestyle Adjustments
   • Regular low-impact exercises, such as yoga or swimming, can reduce stiffness and improve overall fitness.
   • Cognitive Behavioral Therapy (CBT) can help patients manage the mental health challenges associated with chronic pain.
3. Alternative Therapies
   • Acupuncture and massage therapy may provide additional symptom relief for some patients.
   • Practicing mindfulness and stress-reduction techniques can enhance coping strategies.

POTS Treatment

Managing POTS often requires a combination of medical interventions and lifestyle modifications to improve blood circulation and reduce symptoms:

1. Medications
   • Volume Expanders: Medications like fludrocortisone increase blood volume.
   • Heart Rate Control: Beta-blockers or ivabradine can help reduce a fast resting heart rate.
   • Vasoconstrictors: Drugs such as midodrine improve blood vessel tone and reduce orthostatic symptoms.
2. Dietary and Lifestyle Changes
   • Increased Salt and Fluid Intake: Consuming more fluids and salt can help stabilize blood pressure.
   • Compression Garments: Wearing compression socks can prevent blood pooling in the lower extremities.
   • Avoiding triggers such as heat, dehydration, and prolonged standing.
3. Physical Therapy
   • A gradual exercise program focused on recumbent or seated activities like cycling can improve circulation without exacerbating symptoms.

Summary

The overlap between POTS and fibromyalgia continues to raise important questions, such as "Are fibromyalgia and POTS related?" Understanding their shared features, such as fatigue, joint pain, and cognitive dysfunction, can lead to better diagnostic and management approaches.

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Frequently Asked Questions

1. What does POTS mean?
   POTS stands for postural orthostatic tachycardia syndrome, a condition characterized by an abnormal increase in heart rate when standing, often accompanied by dizziness, lightheadedness, or fainting.
2. What illness can mimic POTS?
   Illnesses such as inappropriate sinus tachycardia, vasovagal syncope, dehydration, chronic fatigue syndrome (ME/CFS), and certain heart conditions like mitral valve prolapse can mimic POTS symptoms.
3. What is POTS often misdiagnosed as?
   Doctors frequently misdiagnose POTS as an anxiety disorder, panic attacks, chronic fatigue syndrome, or inappropriate sinus tachycardia.
4. What disorders are comorbid with POTS?
   Common comorbidities include fibromyalgia, chronic fatigue syndrome (ME/CFS), Ehlers-Danlos syndrome (EDS), mast cell activation syndrome (MCAS), small fiber neuropathy, irritable bowel syndrome (IBS), and autoimmune diseases like lupus and Sjögren’s syndrome.
5. What autoimmune disease causes POTS syndrome?
   Autoimmune diseases such as lupus, Sjögren’s syndrome, and autoimmune thyroiditis (Hashimoto's disease) are associated with POTS.
6. What autoimmune diseases are linked to fibromyalgia?
   Fibromyalgia is often associated with autoimmune diseases such as lupus, rheumatoid arthritis, and Sjögren’s syndrome.
7. Is fibromyalgia a form of dysautonomia?
   While fibromyalgia is not officially classified as a form of dysautonomia, it shares many symptoms with autonomic disorders, such as fatigue, dizziness, and gastrointestinal disturbances.
8. Do people with POTS develop MS?
   There is no direct evidence linking POTS to an increased risk of developing multiple sclerosis (MS).
9. Is fibromyalgia common with POTS?
   Yes, fibromyalgia is relatively common in people with POTS. Studies suggest that around 20% of individuals with POTS also have fibromyalgia.
10. What is the disease associated with fibromyalgia?
    Fibromyalgia is often associated with conditions such as chronic fatigue syndrome, irritable bowel syndrome (IBS), migraine, and Ehlers-Danlos syndrome.
11. What does a POTS flare-up feel like?
    A POTS flare-up typically involves symptoms such as lightheadedness, dizziness, rapid heart rate, brain fog, nausea, headaches, and tremors when standing. Symptoms often subside when lying down.
12. POTS vs. Vasovagal Syncope: What’s the Difference?
    POTS is characterized by a rapid heart rate and symptoms like dizziness when standing, while vasovagal syncope involves fainting triggered by specific stimuli, such as stress or pain.
13. Can you have both POTS and fibromyalgia?
    Yes, fibromyalgia is one of several conditions that commonly co-occur with POTS.

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References

1. Staud R. (2008). Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia. Current Rheumatology Reports, 10(6), 463–466. https://doi.org/10.1007/s11926-008-0076-8
2. Yun, D. J., Choi, H. N., & Oh, G. S. (2013). A case of postural orthostatic tachycardia syndrome associated with migraine and fibromyalgia. The Korean Journal of Pain, 26(3), 303–306. https://doi.org/10.3344/kjp.2013.26.3.303
3. Fairweather, D., et al. (2023). High overlap in patients diagnosed with hypermobile Ehlers-Danlos syndrome or hypermobile spectrum disorders with fibromyalgia and 40 self-reported symptoms and comorbidities. Frontiers in Medicine, 10, 1096180. https://doi.org/10.3389/fmed.2023.1096180
4. Cooksey, R., et al. (2022). Exploring gender differences, medical history, and treatments used in patients with fibromyalgia in the UK using primary-care data: a retrospective, population-based, cohort study. The Lancet Rheumatology, 4(S20).
5. Schondorf, R., & Low, P. A. (1993). Idiopathic postural orthostatic tachycardia syndrome: An attenuated form of acute pandysautonomia? Neurology, 43(1), 132–137. https://doi.org/10.1212/WNL.43.1_Part_1.132