Dizziness and localized pain are often concurrent in patients with balance or psychological disorders

Eva-Maj Malmström 1 , 2 , Måns Magnusson 2 , Johan Holmberg 2 , Mikael Karlberg 2  and Per-Anders Fransson 3
  • 1 Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
  • 2 Department of Clinical Sciences, Lund University, Lund, Sweden
  • 3 Department of Clinical Sciences, Lund University, S-221 85 Lund, Sweden
Eva-Maj Malmström
  • Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
  • Department of Clinical Sciences, Lund University, Lund, Sweden
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, Måns Magnusson, Johan Holmberg, Mikael Karlberg and Per-Anders Fransson

Abstract

Background and aims

Symptoms of dizziness and pain are both common complaints and the two symptoms often seem to coincide. When symptoms appear concomitant for sustained periods of time the symptoms might maintain and even exacerbate each other, sometimes leading to psychological distress. In order to evaluate such comorbidity we studied patients referred to a vestibular unit and to a psychiatric outpatient clinic with respectively balance disorders and psychological issues.

Methods

Consecutive patients referred to a vestibular unit (n = 49) and a psychiatric outpatient clinic (n = 62) answered the Dizziness Handicap Inventory (DHI) questionnaire and a questionnaire detailing occurrence of dizziness and pain.

Results

The experience of dizziness and pain often coincided within individuals across both clinical populations, especially if the pain was located to the neck/shoulder or the back (p = 0.006). Patients who reported dizziness had significantly more often pain (p = 0.024); in the head (p = 0.002), neck/shoulders (p = 0.003) and feet (p = 0.043). Moreover, patients who reported dizziness stated significantly higher scoring on emotional (p < 0.001) and functional (p < 0.001) DHI sub-scales. Furthermore, patients who reported an accident in their history suffered significantly more often from dizziness (p = 0.039) and pain (p < 0.001); in the head (p < 0.001), neck/shoulders (p < 0.001) and arms (p = 0.045) and they scored higher on the emotional (p = 0.004) and functional (p = 0.002) DHI sub-scales.

Conclusions

The findings suggest comorbidity to exist between dizziness and neck/shoulder or back pain in patients seeking health care for balance disorders or psychological issues. Patients suffering from dizziness and pain, or with both symptoms, also reported higher emotional and functional strain. Thus, healthcare professionals should consider comorbidity when determining diagnosis and consequent measures.

Implications

Clinicians need to have a broader “receptive scope” in both history and clinical examinations, and ask for all symptoms. Although the patients in this study visited a vestibular unit respectively a psychological clinic, they commonly reported pain conditions when explicitly asked for this symptom. A multimodal approach is thus to favor, especially when the symptoms persist, for the best clinical management.

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