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

Abstract

Background and aim Chronic 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. Methods During 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. Results The 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 conclusion The 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. Theref...

Dizziness and physical health are associated with pain in dizzy patients—A cross‐sectional study

“…It was higher than that in the Norwegian population and higher than that reported by others on patients with dizziness. In the latter group reports on general pain vary between 40% and 58% (Iglebekk et al, 2013;Iglebekk et al, 2015;Malmstrom et al, 2019). In a study on patients with uncompensated vestibular VSS-V, mean (SD) 9.0 (6.9) 5.4 (6.1) 9.9 (7.3) 7.8 (6.7) 8.4 (7.0) 5.4 (5.9)…”

“…The latter is comparable to our results; 59% of our patients had neck pain. Others have reported the prevalence of neck pain to vary between 33% and 92% (Bjorne et al, 1998;Iglebekk et al, 2013Iglebekk et al, , 2015Kalland Knapstad et al, 2020;Kvåle et al, 2008;Malmstrom et al, 2019). Direct comparison between studies is difficult.…”

“…It was higher than that in the Norwegian population and higher than that reported by others on patients with dizziness. In the latter group reports on general pain vary between 40% and 58% (Iglebekk et al., 2013; Iglebekk et al., 2015; Malmstrom et al., 2019). In a study on patients with uncompensated vestibular disorder, 29% had widespread pain according to the pain drawing (Kvåle et al., 2008), comparable to the finding in the present study.…”

Review of the pathology underlying benign paroxysmal positional vertigo

“…68 Patients with pain benefit from otolith repositioning maneuvers. 69 Whether myalgia, fibromyalgia, and pain influence detachment of otoconia remains unclear because most such studies are observational and the results are based on self-scoring questionnaires. Whether neck pain is the cause or consequence of BPPV also remains unclear.…”

A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV

“…With this movement, the inner ear labyrinth will be at a 90° forward bending; 18 if we add the 45° of head forward flexion Step I, the cupula of the AC will now be at 135° forward bending. 18 , 19 , 20 ( Fig. 2 ) In this position, loose otoconia in the AC will be displaced towards the lowest gravitational point of the canal, first using the inertia generated by the deceleration of the movement and then by gravity ( Fig.…”