title: Vestibular dysfunction in patients with chronic pain or underlying neurologic disorders.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Physician Services, PSC, PO Box 22430, Lexington, KY 40522-2430. correspondence@kentuckypaincare.com.
authors.forename: John W
authors.initials: JW
authors.lastname: Gilbert
authors.forename: Manuel
authors.initials: M
authors.lastname: Vogt
authors.forename: Robert E
authors.initials: RE
authors.lastname: Windsor
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Mick
authors.forename: Gay B
authors.initials: GB
authors.lastname: Richardson
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Storey
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Herder
authors.forename: Susan
authors.initials: S
authors.lastname: Ledford
authors.forename: Dee A
authors.initials: DA
authors.lastname: Abrams
authors.forename: Mary Katherine
authors.initials: MK
authors.lastname: Theobald
authors.forename: Dana
authors.initials: D
authors.lastname: Cunningham
authors.forename: Louise
authors.initials: L
authors.lastname: Kelly
authors.forename: Kimberly V
authors.initials: KV
authors.lastname: Herring
authors.forename: Michael L
authors.initials: ML
authors.lastname: Maddox
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods*; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications* / Q000175:diagnosis; D004856:Postural Balance; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D015837:Vestibular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy