Musculoskeletal Medicine and PainORIGINAL ARTICLE

Vestibular Dysfunction in Patients With Chronic Pain or Underlying Neurologic Disorders

John W. Gilbert, MD; Manuel Vogt, DO; Robert E. Windsor, MD; Gregory E. Mick, DO; Gay B. Richardson, MD; Benjamin B. Storey, MD; Stephanie L. Herder, MD; Susan Ledford, AA; Dee A. Abrams, PA-C; Mary Katherine Theobald, RN; Dana Cunningham, CMA; Louise Kelly, PA-C; Kimberly V. Herring, RN, ADN, BSN; and Michael L. Maddox, BA
Notes and Affiliations
Notes and Affiliations

Received: March 19, 2013

Accepted: October 28, 2013

Published: March 1, 2014

J Osteopath Med; 114(3): 172-178

Context: Individuals with vestibular dysfunction are at increased risk for falling. In addition, vestibular dysfunction is associated with chronic pain, which could present a serious public health concern as approximately 43% of US adults have chronic pain.

Objectives: To assess the incidence of vestibular dysfunction in patients receiving medication for chronic, noncancer pain or other underlying neurologic disorders and to determine associated follow-up therapeutic and diagnostic recommendations.

Methods: The authors conducted a retrospective medical record review of consecutive patients who were treated in their private neuroscience practice with medications for chronic pain or underlying neurologic disorders in 2011. All patients underwent a series of tests using videonystagmography for the assessment of vestibular function. Test results and recommendations for therapy and additional testing were obtained.

Results: Medical records of 124 patients (78 women, 46 men) were reviewed. Vestibular deficits were detected in 83 patients (66.9%). Patient ages ranged from 29 through 72 years, with a mean age of 50.7 years for women and 52.5 years for men. Physician-recommended therapy and follow-up testing were as follows: 32 patients (38.6%), neurologic examination and possible magnetic resonance (MR) imaging or computed tomography (CT) of the brain; 26 patients (31.3%), vestibular rehabilitation therapy only; 22 patients (26.5%), vestibular and related balance-function rehabilitation therapy, further neurologic examination, and possible MR imaging or CT; 2 patients (2.4%), balance-function rehabilitation therapy and specialized internal auditory canal high-magnification MR imaging or CT to assess for acoustic neuroma; and 1 patient (1.2%), specialized internal auditory canal high-magnification MR imaging or CT to evaluate for possible intracanalicular acoustic neuroma.

Conclusions: Patients being treated with medications for chronic, noncancer pain or other underlying neurologic disorders may have a higher-than-average incidence of vestibular dysfunction. Baseline assessment and monitoring of the vestibular apparatus may be indicated for these patients.

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