How neck pain and cervical spine instability cause nausea, gastroparesis and other digestive problems

Ross Hauser, MD

Nausea due to neck pain, neck stiffness, and neck instability

When we see patients with problems of cervical spine instability, they usually present with many symptoms, not just one. These symptoms are not confined to neck pain, arm numbness, headaches, or the traditional symptoms of cervical spine instability or cervical radiculopathy, some of these symptoms these people describe can seem remote or unrelated to their neck problems, but they are not.  One of these symptoms patients may discuss with us is the constant presence of nausea and/or gastroparesis, a problem with their stomach’s ability to empty itself of food. While many readers may not be familiar with the term gastroparesis, they are familiar with the symptoms, heartburn, vomiting, sensation of being bloated, a constantly full stomach, and of course nausea.

In this article, we want to stress that nausea and digestive problems can be caused by many problems.

The causes of nausea. What are we seeing in this image?

As stated, there are many reasons and many investigations needed to understand the cause of someone’s nausea. In this article we will go down the investigative route of cervical spine instability. In this illustration we see that Nausea can be caused by hormonal balance, food sensitivities, medications, overheating and digestive problems such as small inetstinal bowel overgrowth and structural gastrointestinal problems of the stomach and gall bladder.

But nausea can also find origins in:

Below I will briefly describe these conditions.

The majority of patients are teenage girls and younger women

Gastroparesis is synonymous with delayed gastric emptying and it is becoming an epidemic among teenage girls and women in their twenties. In some patients gastroparesis can be caused by vagus nerve injury in the neck. Often people are diagnosed with autoimmune disease, hysteria, or depression. Typically when no mechanical obstruction is found. Many are told that cause of the condition is psychological. They are examined for an eating disorder.

Recently one person described swallowing difficulties that were made worse by something acutely shifting in their neck. They reported the neck issues were soon resolved with chiropractic visits but the swallowing difficulties continued.

Scans and testing revealed no obvious cause of their swallowing issues. However, this person was told that the x-ray they took revealed a lack of neck curvature. Further physical therapy and chiropractic adjustments did not help their swallowing difficulties.

Finally a diagnosis of allergy and food sensitivity was given and a this person’s doctors now tackled the problem as Eosinophilic Esophagitis. An overactive immune system reacting to food.

This person’s problems continued with weight loss, then a diagnosis of hypothyroidism which typically means you gain weight.  This was followed by a diagnosis of adrenal fatigue (which could account for unexplained weight loss), Leaky gut syndrome, low stomach acid, inadequate gut flora with yeast overgrowth.

This person tells that they are on a food elimination diet, a Low Fermentation Diet to combat small intestinal bacterial overgrowth and are taking supplementation to help with nutritional deficiencies.

Is this a person we can help? Yes, if problems in the neck can be identified as causing disruption of the digestive cycle. Also, this will not be a quick fix. The road to recovery will be long and challenging. Some people will not be successful in their treatment. Many factors go into the cause of non-successful treatment.

Why does my neck pain make me nauseous? Nausea causes can be difficult to pinpoint

As stated above, nausea can be caused by many problems. Nausea is sometimes a problem buried so deep in the patient’s medical issues that a great deal of work may be required to find NOT THE SOURCE of nausea, but THE SOURCES of their nausea.

Listen to what we have heard from patients, these are possible sources of nausea. Possibly your causes of nausea.

This is just a small sampling of the problems our patients come to us for. The cause of nausea can be complicated.

Increased tension (stretch) on the medulla nausea center.

The medulla (that portion of the lower brain stem) houses the chemoreceptor trigger zone or the medulla nausea center. The chemoreceptor trigger zone which can cause nausea and vomiting can by thrown into chaos by injury, by stroke, or by something else that can cause neuron death and nervous system dysfunction. Chaos for the suffer means nearly untreatable vomiting and nausea. Recently a possible cause from this problem has been discussed by doctors. The compression of the ceratoid sheath and the veins and arteries of the neck.

What are we seeing in this image? Compression of the carotid sheath. A possible cause of nausea.

The carotid sheath is a wrapping of connective tissue or fascia that surrounds the vascular vessels of the neck. It also surrounds the cranial nerves. This is all one neat roll-up of arteries, veins, and nerves. It is also a very tight and compact roll-up packed into this protective tube. But the protective tube can only protect so far. Cervical instability can lead to compression of this tube and all the components within it. This can lead to an impact on the cervical nerves and conditions and symptoms thought to be neurologic in nature.

We see many patients with this type of compression and the neurologic-like symptoms of nausea and vomiting. We are not the only specialists who see this and understand that this is not so rare of a phenomena.

In 2015, doctors at the Department of Neurological Surgery, Saint Louis University wrote up, what they considered at the time, a very remarkable case of “Intractable vomiting caused by vertebral artery compressing the medulla.” This paper was not published in a gastroenterologist journal it was written in the Journal of craniovertebral junction and spine.(1)

Hear is the patient’s story and the learning points:

The story:

Explanatory notes: The patient had vertebro-basilar arteries that were stretched with caused a narrowing of the vessels. The vertebral artery was compressing the brain stem.

In this case the patient had microvascular decompression. According to the doctors “the postoperative course was uneventful, and the patient was kept in the hospital to transition her from gastrostomy tube feedings to regular oral feeding. The patient was discharged from the hospital without any antiemetic medication and was documented to have started gaining weight. At her 2-year postoperative visit, the patient had a non-focal neurologic exam without recurrence of her prior nausea or vomiting. She had also achieved a normal body mass index (BMI).

The doctors concluded: “This case demonstrated the importance of neurological investigations in the isolated intractable vomiting patient without a clear evidence of peripheral cause and including a central nervous system etiology on the differential, and the role of (decompression surgery) in achieving (a) cure.”

At our center we offer non-surgical methods of achieving “decompression” this is discussed below.

When my neck hurts, I want to vomit: Does a pinched nerve cause nausea?


Nausea and gastroparesis caused by cervical spine instability

In this video Ross Hauser, MD describes the problems and symptoms of nausea and gastroparesis caused by cervical spine instability.

Summary transcriptions and explanatory notes:

At 0:54 of this video, Dr. Hauser refers to Vagus nerve compression and how this could cause gastroparesis.

Injury to the vagus nerve, the cause of nausea?

We have two vagus nerves. One on the left side of the neck and the one on the right side of the neck. Among the many functions of the vagus nerve is that it provides 75% of the total input for the parasympathetic nervous system, aptly called the rest and digest system. The vagus nerve is responsible for managing our intestinal activity as well as managing the sphincter muscles in the gastrointestinal tract.

In some cases, our patients are recommended to use a vagus nerve stimulator between our Prolotherapy treatments. Prolotherapy treatments which are our main treatments are explained below in the research.

What are we seeing in this image?

Vagus nerve stimulators can stimulate the nucleus tractus solitarius. When food touches your mouth, your body begins sending chemical and mechanical messages to stimulate the gastrointestinal tract to prepare the digestive system for food intake. The vagal nerve conveys primary afferent information from the intestinal mucosa to the brain stem. Activation of vagal afferent fibers results in inhibition of food intake (Sends signals to tell you to stop overeating), gastric emptying, and stimulation of pancreatic secretion.

 Vagus nerve stimulators can stimulate the nucleus tractus solitarius. When food touches your mouth, your body begins sending chemical and mechanical messages to stimulate the gastrointestinal tract to prepare the digestive system for the food intake. The vagal nerve conveys primary afferent information from the intestinal mucosa to the brain stem. Activation of vagal afferent fibers results in inhibition of food intake (Sends signals to tell you to stop overeating), gastric emptying, and stimulation of pancreatic secretion.

Vagus nerve stimulators can stimulate the nucleus tractus solitarius. What does this mean?

When food touches your mouth, your body begins sending chemical and mechanical messages to stimulate the gastrointestinal (GI) tract to prepare the digestive system for food intake. A good explanation of what happens next and the vagus nerve involvement is explained in this paper published in the journal Current Medicinal Chemistry. (4)

So this is what is going on with the vagus nerve:

So where does the nucleus tractus solitarius come into play?

How disruptions in the vagus nerve cause digestive problems

What are we seeing in this image?

The vagus nerve supplies input to the stomach that helps manage your stomach muscles. If this input is compromised, in other words, the vagus nerve is sending bad or confusing messages to your stomach, your stomach may not push food out into your small intestines. This means food remains in your stomach longer than it should. This leads to the common symptoms of bloating, fullness, nausea, and finally when your stomach has had enough, the initiation of the vomiting response. In this illustration, dysfunction of the pyloric sphincter between the stomach and the small intestines is isolated as a problem of vagus nerve compression or injury.

The vagus nerve supplies input to the stomach that helps manage your stomach muscles. If this input is compromised, in other words the vagus nerve is sending bad or confused messages to your stomach, your stomach may not push food out into your small intestines. This means food remains in your stomach longer than it should. This leads to the common symptoms of bloating, fullness, nausea, and finally when your stomach has had enough, the initiation of the vomiting response. In this illustration, dysfunction of the pyloric sphincter between the stomach and the small intestines is is isolated as a problem of vagus nerve compression or injury.

Cervical vagopathy – poor vagus function

Dr. Hauser describes the term cervical vagopathy. This relates to poor vagus function and it is seen as a precursor to illness and makes recovery from diseases difficult. Low vagus nerve function has four main manifestations on the human body that increase the risk for almost all human diseases: chronic inflammation, elevated oxidative stress, sympathetic dominance (a condition of feeling overwhelmed by burden which leads to stress and is fed by the adrenaline (fight-flight) action system, and coagulopathy (problems with blood clotting) which can lead to joint inflammation, joint swelling, and joint pain. Next the treatment of this problem with Prolotherapy.

Digestion & the Vagus Nerve: Sphincter function and related symptoms affected by neck instability

Ross Hauser, MD discusses digestion and the vagus nerve as it relates to the sphincter function. In the histories of patients who we see in our center, they often feel like they hit a wall with regard to finding resolution of symptoms or their digestion conditions because the focus has been too narrow. When looking at many digestive symptoms through the aspect of vagus nerve health, many times solutions can be found because the vagus nerve innervates many vital digestive organs. Thus, in our center, we find that patients who have digestive complaints as part of their constellation of symptoms that also point to vagus nerve impairment, that the upper cervical area and cervical curve should be analyzed and examined to see if this could be the cause of the issues.

How cervical instability can cause chronic nausea – the relationship between nausea and the neck

One of the most common symptoms that our patients with cervical instability complain of is nausea. In this video, Ross Hauser, MD gives an overview of the mechanisms by which cervical instability causes nausea. In our experience, when a person’s neck stability and curve are restored, the nausea is typically resolved. Of course, there are many reasons for nausea, but the primary focus of this presentation is the relationship between nausea and the neck.

The importance of not damaging the vagus nerve in pylorus-preserving gastrectomy

I want to use a study not to debate the use of pylorus-preserving gastrectomy, which may be a needed and necessary procedure for people with cancer, but to demonstrate a “newfound awareness,” of the role of the vagus nerve in digestion and the importance of not damaging or removing the vagus nerve during this surgery.

Some of you reading this article may have been recommended to this type of surgery because you are considered a very complicated non-cancer case and you are not responding to traditional treatments for the digestive and gastrointestinal distress you are suffering from. This surgery will remove part of your stomach. Pylorus-preserving gastrectomy means that the surgeons will leave behind that portion of your stomach with the pyloric valve intact. If the pyloric valve is removed, the food in the stomach will move too quickly into the small intestine and cause another problem, post-gastrectomy syndrome.

An October 2020 study (5) produced by gastrointestinal surgeons gave us this concern about nerve preservation:

“Function-preserving gastrectomy, especially pylorus-preserving gastrectomy, can improve the quality of life and has been widely recognized. With the development of surgical techniques and equipment, nerve preservation has become a new requirement in the era of “precision medicine”, but the preservation of the celiac branch of the vagal nerve remains controversial in gastric cancer surgery.

Current researches have shown that the preservation of the celiac branch of the vagal nerve is safe and feasible in patients with early gastric cancer. Although controversial, nerve preservation may play a role in preventing gallstones, regulating gastric emptying, reducing dumping syndrome, alleviating chronic diarrhea, reducing gastroesophageal reflux, and inhibiting bile reflux.

The significance of the celiac branch of the vagal nerve in gastric cancer surgery is worth further attention and exploration to promote the development of function-preserving gastrectomy and improve the quality of life of patients.”

What is being said here?

Surgeons are discussing amongst themselves the controversial decision to preserve the celiac branch of the vagal nerve in gastric cancer surgery. Why is it controversial? It adds a layer to the already difficult and challenging procedure and it is unclear if it will help the patient. This is however not what we are debating in this article. This study is used to display that some surgeons recognize the important functions of the celiac branch of the vagal nerve and something should be done to preserve it when possible.

Those functions outlined above include:

Preserving, maintaining, restoring the proper celiac branch of the vagal nerve function, is then seen as a means to alleviate many digestive and gastrointestinal problems.

Treatment Surgery:

Some patients with gastroparesis need surgery because their symptoms and problems are not related to the problems outlined above with cervical spine instability.

Over twenty years ago, surgeons wrestled with the best concept in the surgical management of gastroparesis. A paper published in the Journal of the Society of Laparoendoscopic Surgeons (7) noted: “Partial gastrectomy, gastroenterostomy, pyloromyotomy, pyloroplasty and endoscopic dilatation have all been recommended with variable results.” How much has changed? Surgeons are still debating and comparing techniques with various results.

A September 2021 paper in the medical journal Medicine (8) compared the short-term outcomes surrounding the effectiveness and complication rate between different types of pyloromyotomy and gastric electrical stimulation in the treatment of gastroparesis. A pyloromyotomy is an incision in the wall of the pylorus to release pressure or blockage on the connection between the stomach and the small intestine.

Conclusions: “the results suggesting that double double per-oral pyloromyotomy demonstrated better clinical success with similar recurrence and complication rates. In addition, gastric electrical stimulation may result in more recurrence amongst these interventions.”

What if the vagus nerve is suspected of causing problems of gastroparesis? Is Vagotomy warranted?

Some people who contact us have a history of or have been recommended to a vagotomy to help ease the symptoms and look for a cure for gastroparesis. A vagotomy is a surgery that removes all or part of your vagus nerve. Vagotomy is focused on helping people with stomach ulcers. The idea being that by cutting the vagus nerve, (the vagus nerve controls  stomach acid secretion) stomach acids and the problems of acid erosion in the digestive tract can be managed and ulcers can heal. This procedure is not commonly performed as doctors were more eager to provide alternatives this surgery such as proton pump inhibitors.

Treatment Prolotherapy

We have seen many patients who have had numerous gastroenterologist visits, an endoscopy where “nothing was found,” and a diagnosis of gastroparesis. Simply, this person’s stomach is not working right. As mentioned above, the stomach is not contracting normally, the proper amounts of stomach acid are not being released. The pyloric valve is not functioning, opening and closing, correctly.

Upper cervical instability affects the medulla and the area postrema

The medulla, short for medulla oblongata, is part of the brainstem. The signals of the vagus nerves, in fact almost all of the nerves of the body have to travel through the medulla through various nerve pathways or tracts.

Addressing cervical spine instability with Prolotherapy injections:

We have published dozens of papers on Prolotherapy injections as a treatment in difficult to treat musculoskeletal disorders. Prolotherapy is an injection technique utilizing simple sugar or dextrose. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including problems of digestion and a sense of chronic nausea in relation to the brainstem. It should be pointed out that we suggest in our research that “Additional randomized clinical trials and more research into its (Prolotherapy) use will be needed to verify its potential to reverse ligament laxity and correct the attendant cervical instability.” Our research documents our experience with our patients.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal. (9) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.

What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions, including disc herniation, cervical spondylosis, whiplash injury, and whiplash-associated disorderpost-concussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. The obvious should be pointed out, many people who have been diagnosed with these problems also suffer from a variety of digestive problems and swallowing difficulties.

Cervical Spine Stability and Restoring Lordosis

The cervical spine has a natural curve. It acts as a spring or shock absorber for the head. When this curve is gone because of injury, Joint Hypermobility Syndrome, or degenerative cervical disc disease, not only are the arteries and nerves between the vertebrae not protected from the impact of walking or running or jumping or a bumpy car ride, they are subjected to compression from cervical spine instability caused by cervical ligaments that have also been damaged by injury or wear and tear and no longer hold the neck in correct alignment.

The cervical spine has a natural curve. It acts as a spring or shock absorber for the head. When this curve is gone, injury, Joint Hypermobility Syndrome, or degenerative cervical disc disease

The cervical spine has a natural curve. It acts as a spring or shock absorber for the head. When this curve is gone, injury, Joint Hypermobility Syndrome, or degenerative cervical disc disease

Digital motion X-Ray C1 – C2

The digital motion x-ray is explained and demonstrated below. This is one of our tools in demonstrating cervical instability in real-time and motion.

The challenges of cervical instability are many. Fixing cervical neck instability is not something that can be treated simply or easily, it takes a comprehensive non-surgical program to get the patient’s instability stabilized and the symptoms abated. We believe that if you have been going from clinician to clinician, practitioner to practitioner, doctor to doctor, there is a good likelihood that you have problems of cervical neck instability coming from weakness and damage to the cervical ligaments. Our treatments of Comprehensive dextrose Prolotherapy and in some cases Platelet Rich Plasma Prolotherapy can be an answer.

If this article has helped you understand the problems of nausea and gastroparesis and you would like to explore Prolotherapy as a possible remedy, ask for help and information from our specialists

Treating and repairing cervical instability with Prolotherapy: research papers

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Nausea due to neck pain, neck stiffness, and neck instability. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

References

1 Gorton L, Ashour AM, Lebovitz J, Di AC, Abdulrauf SI. Intractable vomiting caused by vertebral artery compressing the medulla: A case report. Journal of craniovertebral junction & spine. 2015 Apr;6(2):89. [Google Scholar]
2 Lu KH, Cao J, Oleson S, Ward MP, Phillips RJ, Powley TL, Liu Z. Vagus nerve stimulation promotes gastric emptying by increasing pyloric opening measured with magnetic resonance imaging. Neurogastroenterol Motil. 2018 Oct;30(10):e13380. doi: 10.1111/nmo.13380. Epub 2018 May 24. PMID: 29797377; PMCID: PMC6160317. [Google Scholar]
3 Lu KH, Cao J, Oleson S, Ward MP, Phillips RJ, Powley TL, Liu Z. Vagus nerve stimulation promotes gastric emptying by increasing pyloric opening measured with magnetic resonance imaging. Neurogastroenterology & Motility. 2018 Oct;30(10):e13380. [Google Scholar]
4 Li Y. Sensory signal transduction in the vagal primary afferent neurons. Current medicinal chemistry. 2007 Oct 1;14(24):2554-63. [Google Scholar]
5 Sun WF, Liang P. Significance of celiac branch of the vagal nerve in function-preserving gastrectomy. Zhonghua wei Chang wai ke za zhi= Chinese Journal of Gastrointestinal Surgery. 2020 Oct 1;23(10):935-8. [Google Scholar]
6 Hui C, Dhakal A, Bauza GJ. Dumping Syndrome. 2020 Nov 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29261889.
7 Danikas D, Geis WP, Ginalis EM, Gorcey SA, Stratoulias C. Laparoscopic pyloroplasty in idiopathic hypertrophic pyloric stenosis in an adult. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2000 Apr;4(2):173. [Google Scholar]
8 Shiu SI, Shen SH, Luo HN. Short-term outcomes of different modalities of pyloromyotomy versus gastric electrical stimulation in the treatment of gastroparesis: A systemic review and meta-analysis. Medicine. 2021 Sep 17;100(37). [Google Scholar]
9 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]

This article was updated October 22, 2021

 

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