Adolescent Chronic Pain, POTS and FND Rehabilitation

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A child or adolescent may experience chronic pain, POTS-related* symptoms, or functional neurological impairments in a complex ways that affects movement, sleep, and mood.  Our program enables children and teens to return to the things they enjoy, including school and other important activities. Our patients range in age from 5 to 22 years old.

*POTS is described below

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Treatment at Shirley Ryan AbilityLab is a collaborative, multidisciplinary, integrated effort.  Your child’s care team will include a:

• Physiatrist, which is a physician specializing in physical medicine and rehabilitation. The physician will direct the care provided by the team, and manage medication. Additional nonmedication-based approaches may be considered and may include acupressure, acupuncture and application of frequency-specific microcurrent. These techniques, if appropriate, would be used to support progress.
• Cognitive behavioral psychologist, who will address sleep issues and stressors that can affect symptoms. Cognitive behavioral techniques, mindfulness and relaxation training help children learn tools for improving the ability to manage symptoms and stressors.
• Occupational therapist, who will address issues of pacing, posture and body mechanics, as well as help develop a daily schedule and evaluate possible individual accommodations needed in the school environment.
• Physical therapist, who will address strengthening, stretching and cardio activities, to aid in relieving pain, and improving endurance and functioning. The PT will also create an individualized home exercise program to help improve conditioning and movement.
• Speech-language pathologist, who will address issues of “brain fog” and cognitive dysfunction that some patients experience in POTS* or from long COVID. The SLP will focus on tools that improve concentration and memory.

Based on your child’s unique needs, the care team will create a treatment plan focused on improving function through graded exercise, pacing, relaxation training and teaching coping strategies. As treatment progresses, your care team will promote the use of these strategies in daily routines. Parents receive education and support to help their child carry over learned pain strategies. Our care is supported by the most current evidenced-based treatment. 

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Program specialists treat a variety of chronic-pain-related conditions, including complex regional pain syndrome (CRPS), abdominal pain, back pain, myofascial pain, headache, nerve pain, joint pain, hypermobility and amplified musculoskeletal pain syndrome (AMPS). Our goal is to improve function by addressing movement, daily activities, sleep and stress management.

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The POTS program treats symptoms and impairment related to the autonomic nervous system. A number of underlying conditions are known to be associated with POTS, including autoimmune diseases and Ehlers-Danlos syndrome. We promote strength, cardiovascular conditioning, cognitive endurance and relaxation skills. Guided by the physician, the team may assist with medication management as well.

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Functional somatic symptoms involve problems in the body’s regulation system that are the result of stress — either physical, psychological or both.  Symptoms can’t be explained by a medical condition, but are real and interfere with functioning and cause significant distress. The disorder affects movement and sensation; for example, the ability to walk, coordinate movement, swallow, see or hear. Symptoms are often inconsistent and may come and go. Early diagnosis and education about the symptoms are an important part of treatment. Our goal is to return children and teens to previous levels of functioning by addressing individual physical and emotional needs.

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Recent studies indicate that many people who had mild COVID symptoms can go on to develop a condition called “long COVID.” It is estimated that about 7 percent of those ages 13 to 22 who developed COVID will have long-COVID functional impairments — physical and cognitive. Symptoms include fatigue, “brain fog,” dizziness and headache, which often worsen with physical activity. Many of these symptoms are similar to those related to central sensitization, which we see in our other populations. Interdisciplinary treatment of long COVID is designed to improve strength and endurance, and reduce cognitive fatigue, pain and orthostatic symptoms.

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For patients who we feel would benefit from a higher intensity of services, inpatient rehabilitation at our flagship hospital is available. Inpatient rehabilitation therapy includes treatment six days a week, three hours a day, typically for a two-week stay in the hospital.  When appropriate, children will transition to our outpatient program.

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The outpatient program — for children from birth through 18 years of age — is located in our flagship hospital at 355 E. Erie Street in Chicago. It consists of one to two half days a week of treatment. Many patients receive both individual and group interventions. We focus on sleep, exercise, pacing and relaxation training.  With changes in lifestyle, children and teens can see a decrease in symptoms and an improvement in quality of life. Through a combination of physical and occupational therapy, psychological counseling and relaxation training, as well as parent education, our goal is to create an integrated plan that will help children return to activities they value.

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We surveyed children who completed the program and:

79% reported their overall status was much or very much improved
80% noted their overall physical functioning was much or very much improved
79% noted their overall ability to cope with pain was much or very much improved

We also surveyed parents of children who completed the program and:

82% reported their child’s overall status was much or very much improved
87% said their child’s overall mood was much or very much improved
80% noted their child’s overall physical functioning was much or very much improved
77% noted their child’s overall ability to cope with pain was much or very much improved

96% of patients and parents indicated that they would recommend our pain program to others