Does a Periaqueductal Gray-vagus Nerve Interface Malfunction Explain the Nat hx With Its Numerous Co-morbidities?

"* The Pain Coping Questionnaire short form~* Functional Disability Inventory (FDI), the primary clinical outcome measure.~* COMPASS-31 and orthostatic hypotension modified for POTS.~* The Pain Response Inventory (PRI)PROMIS Depression~* GAD-7 for anxiety~* Varni/Thompson Pediatric Pain Questionnaire~* Child and Parent Reports of Post-Traumatic Symptoms (CROPS/PROPS)~* Pain Catastrophizing Scale (PCS-C)~* Detailed account of natural history and evolution of POTS and COPCs through MEDYSA (facilitates the assessment of specific syndromic diagnoses based on published criteria, rather than organ-based classification of symptoms)"

Participants will provide a list of all medications taken at each visit time, lifetime history of infections, traumas, and other significant life events.

Subjects will also record new life events, minor traumas, entrance into a flare and menses in Ilumivu's EMA (Ecological Momentary Assessment) phone App

Participants will have an activity monitor loaned for the duration of the study to track their physical activity.

POTS patients will have a periodic 24-hour urine sodium check to determine compliance to intake of salt.

• Participants will complete a fMRI scan without contrast and complete a looming animacy threat task; participants judge the valence of images via button press as they perceive the image.

A bedside tilt test will be performed where blood pressure will be recorded supine and upright positions to confirm/exclude POTS.

• An IV will be place for collection of 4 blood samples, about 12 mL of blood. For each position (lying and standing) the study team will draw 2 tubes each times with 3 mL of blood, for a total of 4 lab tubes (12 mL). Physical exams to assess the 18-tender points described by the American College of Rheumatology for the diagnosis of fibromyalgia and hypermobility/Ehlers-Danlos Syndrome (EDS) exam will be performed in all subjects.

• Participants will provide a stool biospecimen sample at each in-person visit. Stool will be collected in a hat and sample will be swabbed with the swab placed directly into PrimeStore collection tube and the remainder of the sample discarded