High score of dizziness-handicap-inventory (DHI) in patients with chronic musculoskeletal pain makes a chronic vestibular disorder probable

Abstract

Objectives In patients with a vestibular disorder a high score of dizziness-handicap-inventory (DHI) is common. Patients with chronic lithiasis of multiple canals benign paroxysmal positional vertigo (mc-BPPV) can have incapacitating symptoms, e.g. headache, neck pain, musculoskeletal pain, and cognitive dysfunction. Patients with chronic musculoskeletal pain with few objective findings at an ordinary examination of the musculoskeletal system together with unsuccessful interventions can either receive a diagnosis of a biopsychosocial disorder or a diagnosis connected to the dominant symptom. The aim of this investigation is to examine if the DHI- and the DHI subscale scores are abnormal in 49 patients with chronic musculoskeletal pain disorders. In addition, explore the possibility of a chronic mc-BPPV diagnosis. Methods Consecutive prospective observational cohort study at five different physiotherapy clinics. A personal interview using a structured symptom questionnaire consisting of 15 items. Modified Dizziness Handicap Inventory (DHI) including the Physical-, Catastrophic- and Emotional impact DHI subscale scores suggested by the Mayo Clinic was applied. Results Eighty-four percent of the 49 patients have a pathological DHI-score and a potential underlying undiagnosed vestibular disorder. Very few patients have scores at the catastrophic subscale. A correlation is found between the number of symptoms of the structured scheme and the DHI-score. Results from all five physiotherapy clinics were similar. Conclusions Patients with a high number of symptoms and a high DHI-score can have a potential underlying treatable balance disorder like mc-BPPV. Increased awareness and treatment of mc-BPPV may reduce suffering and continuous medication in patients with chronic musculoskeletal pain. Regional Ethical Committee (No IRB 00001870).

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“…The DHI proves valuable, consistent, and valid in gauging self-assessed impairment linked to dizziness. It has been validated in cases of acute [ 25 ] and recurrent [ 26 ] vestibular disorders, as well as chronic dizziness [ 27 ]. Elevated DHI scores have been documented in VM patients [ 28 ], and the questionnaire has been employed to examine the effects of personalized vestibular rehabilitation (VR) programs on balance, gait performance, and self-perceived handicap in VM patient groups [ 29 ].…”

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“…Scientists have long been interested in the relationship between dizziness/balance and pain 39 . The vicious cycle of pain and balance interact through central re exes, and muscle tone control [39][40][41][42] . Malmstrom et al 8 showed in a study of patients referred to a vestibular disorders clinic for balance disorders and a psychiatric clinic for anxiety or depression that there may be an interaction between persistent dizziness, mood, and Neck-Shoulder-Back pain.…”

“…Malmstrom et al 8 showed in a study of patients referred to a vestibular disorders clinic for balance disorders and a psychiatric clinic for anxiety or depression that there may be an interaction between persistent dizziness, mood, and Neck-Shoulder-Back pain. Iglebekk et al 42 Used the Structured symptom questionnaire, Modi ed dizziness handicap inventory (DHI), and DHI subscales to investigate a group of patients with chronic musculoskeletal pain in Norway and Denmark. The investigations concluded that patients with complex chronic musculoskeletal disorders might have undiagnosed vestibular disorders.…”

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“…O impacto da tontura na qualidade de vida, medido pelo DHI, sempre esteve associado à dor no grupo não tratado. Novamente os achados concordam com dados da literatura que mostram alta frequência de alteração no DHI em pacientes com dor crônica musculoesquelética e apresentam alteração vestibular crônica (Iglebekk;Tjell, 2022). A associação entre DHI e tontura foi forte 6.…”