Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain

Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and... AbstractBackground and aimChronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial.MethodsDuring a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire (“yes” or “no” answers during a personal interview) and a follow-up questionnaire were used.ResultsThe responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17–65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2–29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months.Effects of treatment and conclusionThe present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms.ImplicationsPatients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain

Loading next page...
 
/lp/degruyter/treatment-of-chronic-canalithiasis-can-be-beneficial-for-patients-with-zT0H0HcVxy
Publisher
de Gruyter
Copyright
© 2015 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2015.02.002
Publisher site
See Article on Publisher Site

Abstract

AbstractBackground and aimChronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial.MethodsDuring a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire (“yes” or “no” answers during a personal interview) and a follow-up questionnaire were used.ResultsThe responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17–65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2–29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months.Effects of treatment and conclusionThe present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms.ImplicationsPatients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.

Journal

Scandinavian Journal of Painde Gruyter

Published: Jul 1, 2015

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off