Dor, incapacidade, mobilidade articular e sensibilização central em indivíduos com dor cervical crônica com e sem tontura: um estudo transversal

Abstract

Introduction: Cervical pain is a common condition with a multifactorial origin and is frequently associated with complaints of dizziness and vertigo. Despite the recognized neurophysiological interaction between the vestibular system and the upper cervical spine, the coexistence of these conditions has been little explored in the literature. Objectives: To compare the intensity of cervical pain, range of motion, pressure pain threshold, level of cervical disability, and signs of central sensitization in individuals with chronic cervical pain, with and without concurrent dizziness. Methods: This cross-sectional study was conducted between May 2024 and January 2025 at the Laboratory of Vestibular, Craniocervical, and Orofacial Pain Physiotherapy of the Department of Physiotherapy at the Federal University of Rio Grande do Norte (UFRN). It was approved by the Ethics Committee under opinion number 7.185.095 (CAAE: 75844023.8.0000.5537). Participants of both sexes, aged 18 to 59 years, with chronic cervical pain (>3 months), with or without associated chronic dizziness (>3 months), were included. Participants were divided into two groups according to their complaints: the Cervical Pain Group (CG) and the Cervical Pain with Dizziness Group (CPDG). Sociodemographic, clinical-functional, and otoneurological data were collected. The intensity of cervical pain and dizziness was assessed using the Numeric Symptom Rating Scale (NSRS), the degree of cervical disability with the Neck Disability Index (NDI), and signs of central sensitization using the Central Sensitization Inventory (CSI-BR). Cervical range of motion (ROM) was measured using a fleximeter, and pressure pain threshold (PPT) using a craniocervical neuromuscular device (NOD) equipped with an algometry probe. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS). For between-group comparisons, the independent t-test and Mann-Whitney test were applied. Associations between groups and categorical variables were assessed using the Chi-square and Fisher’s exact tests, with the strength of association measured using the Phi (φ) and Cramér’s V coefficients, respectively. The significance level was set at p < 0.05. Results: A total of 40 individuals were evaluated, with 23 in the CG and 17 in the CPDG. Vestibular migraine was the most prevalent diagnosis in the CPDG (41.2%). No significant differences were observed between groups in cervical ROM. Similarly, PPTs in the cervical region showed no significant differences, except for the left upper trapezius, where the CPDG showed a lower PPT (p = 0.042). Regarding cervical disability assessed by the NDI, there was a significant difference between groups (p = 0.001), with the CPDG classified as having moderate disability (64.7%) and the CG as having mild disability (82.6%). For signs of central sensitization, a significant difference was also found between groups (p = 0.003), with 82.4% of CPDG participants scoring above the CSI-BR cutoff, compared to 34.8% in the CG, indicating a strong association between CPDG and signs of central sensitization (Phi = 0.473). Significant differences were also found in the total CSI-BR score (p = 0.001) and its clinical classification (p = 0.030; Phi = 0.511), with higher scores and more severe classifications in the CPDG compared to the CG. Conclusion: The CPDG presented higher intensity of cervical pain during evaluation and over the past week, greater cervical disability, and more symptoms of central sensitization compared to the CG. No significant differences for these outcomes were observed in the CG. No significant differences were found between groups in cervical range of motion and pressure pain threshold. These findings highlight the complexity of cervical pain with dizziness and suggest that treatment should be more individualized. Further studies are needed to better understand this relationship.