A clinical study of patients with concurrent dizziness and neck pain
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Dizziness is a relatively common complaint with a heterogeneous group of patients with several plausible causes. There has long been a controversy regarding the role of the cervical spine in dizziness and balance issues, even though there are well-established physiological connections between the vestibular, visual and cervical proprioceptive systems In addition, previous studies have shown that concurrent dizziness and neck pain exist in both patients with primary dizziness and patients with primary neck pain, resulting in a common clinical issue. However, there is little knowledge about the prevalence of patients with concurrent dizziness and neck pain and how neck pain influences patients with dizziness and balance. This project was a cross-sectional study of patients referred for either dizziness or neck pain to one of two outpatient clinics − an ear, nose and throat clinic or a spine clinic − both at Haukeland University Hospital in Bergen. The overall object of this thesis was to examine to what extent and how neck pain influences dizziness in terms of physical and dizziness characteristics, dizziness severity, postural control and quality of life. Our findings are presented in four papers. Paper I was a systematic review of the clinical characteristics of patients with cervicogenic dizziness. Only eight out of 2161 articles met our inclusion criteria. We found that reduced postural control measured with posturography was the most common clinical finding in patients with cervicogenic dizziness compared with other populations. Paper II examined differences in dizziness disability and quality of life in patients with and without neck pain, referred for dizziness to the ear, nose and throat clinic. Additionally, we examined whether neck pain was associated with a nonvestibular or vestibular diagnosis. We found that patients with additional neck pain reported higher dizziness disability and lower quality of life. In addition, there was no association between neck pain and the presence or absence of a vestibular disorder. Paper III explored the relationship between the pressure pain threshold in the neck and postural control in patients referred to both clinics. The patients were divided according 9 to their referred clinic and thus their primary complaint. In the patients referred for dizziness as the main complaint, we found a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex and generalized pain. The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain. Neither of these relationships were present in the neck pain group. In Paper IV, we explored clinical symptoms and physical findings in patients with concurrent neck pain and dizziness from both centers and examined whether they differed from patients with dizziness alone. Both neck pain groups were associated with certain dizziness characteristics and increased physical impairment. The neck pain group, having dizziness as their primary complaint, had the highest symptom severity score. The overall findings of this thesis indicate that neck pain may affect postural control, dizziness symptoms, physical impairments and quality of life. As the relationship between dizziness and neck pain is a controversial topic, these finding may be helpful and should be considered when examining patients with concurrent complaints, regardless of diagnosis.
Has partsPaper I: Knapstad MK, Nordahl SHG, Goplen FK. Clinical characteristics in patients with cervicogenic dizziness: A systematic review. Health Science Reports. 2019;2(9):e134. The article is available at: http://hdl.handle.net/1956/22258
Paper II: Knapstad MK, Goplen F, Skouen JS, Ask T, Nordahl SHG. Symptom severity and quality of life in patients with concurrent neck pain and dizziness. Disability & Rehabilitation. 2020;42(19):2743-2746. The article is not available in BORA due to publisher restrictions. The published version is available at: https://doi.org/10.1080/09638288.2019.1571640
Paper III: Knapstad MK, Goplen FK, Ask T, Skouen JS, Nordahl SHG. Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain - a cross-sectional study. BMC Musculoskeletal Disorders. 2019;20(1):528. The article is available at: http://hdl.handle.net/1956/22267
Paper IV: Knapstad MK, Nordahl SHG, Skouen JS, Ask T, Goplen FK. Neck pain associated with clinical symptoms in dizzy patients-A cross-sectional study. Physiotherapy Research International. 2020;25(2):e1815. The article is available at: http://hdl.handle.net/1956/22268