Neck pain and Lyme Disease: Will treating neck pain make Lyme Disease symptoms go away?

Ross Hauser, MD

When a patient comes into our office, and they have a diagnosis of Lyme Disease and have cervical spine instability, we often see that when the issues of cervical instability are addressed, the problems of Lyme Disease are greatly alleviated and sometimes eliminated.

In the many patients we see with cervical spine instability, chronic neck pain, and neurological challenges, there is sometimes a concurrent diagnosis of Lyme Disease. It is often thought that neck pain is a symptom of Lyme Disease, and that is why the neck pain is there, for many people it is. Neck pain is also a symptom of cervical spine instability which in some Lyme Disease patients, the neck problems were already there and now these neck problems are compounding their Lyme disease symptoms.

Article outline

• “Healthcare providers frequently struggle to provide effective care to patients with Chronic Lyme-associated symptoms”
• Even when there is increased awareness of the potential of Lyme Disease in a symptomatic patient – treatments still do not help.
• Is it really Lyme Disease?
• Is it Lyme Disease or cervical spine instability causing your symptoms? Uncertain clinical consequences because people are not getting better.
• The problem of being successfully treated for Lyme Disease and the continuation of symptoms.
• Case study: Treating cervical spine instability treats and alleviates symptoms attributed to Lyme Disease.
• Postural orthostatic tachycardia syndrome (POTS) and Lyme disease.
• POTS – Lyme Disease Treatments.
• What are we seeing in this image?
• Prolotherapy, the curve of the neck and blood flow.

Other symptoms that may have existed before the Lyme Disease diagnosis including a tingling or numbness sensation, symptoms we see in cervical spine instability patients, especially in the arms, is also attributed to being a symptom of Lyme Disease. Nerve issues such as facial palsy and slurred speech are thought to be problems of Lyme Disease. Problems of cognition, memory loss, confusion, mood swings, and other problems considered mental health issues are also thought to be symptoms of Lyme Disease. While these problems can be attributed to the progression of Lyme Disease, these are also symptoms and manifestations we see in our cervical spine instability patients. So here we are, which came first? Symptoms of cervical spine instability or symptoms of Lyme Disease? To the patients, it may not matter because they are stuck in a myriad of symptoms. Some of their stories sound like this:

I am in perfect health except:

I have Lyme Disease and I have digestive and gut issues. I suffer from lightheadedness and dizziness. I have brain fog and memory recall issues. As far as my doctors are concerned, I only have anxiety. I have been sent to numerous cardiovascular tests and assessments. These tests always come back “normal.”  I am, according to my doctors, “in perfect health.”

I am confused because there is nothing wrong with me except a herniated disc in my neck that the surgeon wants to operate on.

I have a diagnosis of Ehlers-Danlos Syndrome (hypermobile type), Postural Orthostatic Tachycardia Syndrome (POTS), TMJ, Lyme disease, IBS, dizziness, and more. One doctor said I don’t have anything wrong with me except a bulging disc at C4/5. He recommended surgery. One doctor says I have Chiari malformation but another doctor says I don’t. 

When a patient comes into our office, and they have a diagnosis of Lyme Disease and have cervical spine instability, we often see that when the issues of cervical instability are addressed, the problems of Lyme Disease are greatly alleviated and sometimes eliminated.

“Healthcare providers frequently struggle to provide effective care to patients with Chronic Lyme-associated symptoms”

Doctors at the University of Amsterdam in the Netherlands published a paper in the journal BioMed Central primary care (7) in which they acknowledge “Healthcare providers frequently struggle to provide effective care to patients with Chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system.” The purpose of their study then was to assess “a combined medical and communication science approach, and aims to assess patients’ experiences with chronic Lyme disease & chronic Lyme disease-related care. . . ” with the goal of identifying concerns in patients “and provide potential ways to improve communication with them.” (The communication between doctor and patient).

The researchers found central concerns, they are:

• The experience of significant symptoms
• The patients do not feel they get adequate relief from conventional medical practitioners for their significant symptoms that are largely invisible to the outside world.
• The patients experience a sense of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner.

Clearly these concerns should be addressed with patients suffering from Chronic Lyme-associated symptoms.

Even when there is increased awareness of the potential of Lyme Disease in a symptomatic patient – treatments still do not help

A June 2022 paper in the European journal of public health (8) found even when there is a an overall improvement in Lyme borreliosis awareness (through an educational intervention in general practice) and referrals among general practitioners (to more advanced care, these results did not show any effect of the intervention on clinical outcomes of Chronic Lyme-associated symptoms.

This is from an email: It has been edited for clarity: “I have struggled with upper neck discomfort and tension for nearly four years now, and it has progressively gotten worse over time. I began having symptoms of dizziness, inability to concentrate, and a plethora of other neurological/physical symptoms as well. In an effort to get a diagnoses, I saw a functional medicine doctor. I did multiple blood tests and was diagnosed with Lyme Disease, Babesia, and Bartonella infections.

I’ve been on a protocol to kill those infections, but still struggle with neck tensions and pain. I then went to a chiropractor, and he performed X-rays of my upper cervical. He noticed I had a c1-c2 “subluxation” and started treating me for it. However, his treatments have typically made me feel worse than better most times I see him.”

Is it really Lyme Disease?

An April 2022 study in The American journal of medicine (9) comes to us from the University of Iowa Hospitals and Clinics and the Johns Hopkins University School of Medicine with the suggestion that while “prior studies have demonstrated that Lyme disease is frequently over-diagnosed.  . . few studies describe which conditions are misdiagnosed as Lyme disease.”

In this study of 1261 referred patients, 1061 (84%) had no findings of active Lyme disease, with 690 (65%) receiving other diagnoses; resulting in 405 (59%) having newly diagnosed medical conditions, 134 (19%) attributed to pre-existing medical issues, and 151 (22%) with both new and pre-existing conditions.

• Leading diagnoses were anxiety/depression 222 (21%),
• Fibromyalgia 120 (11%),
• Chronic fatigue syndrome 77 (7%),
• Migraine disorder 74 (7%),
• Osteoarthritis 62 (6%), and
• sleep disorder/apnea 48 (5%).
• Examples of less frequent but non-syndromic diseases newly diagnosed included multiple sclerosis, malignancy, Parkinson’s disease, sarcoidosis,  amyotrophic lateral sclerosis.

Conclusions: “Most patients with long-term symptoms have either new or pre-existing disorders accounting for their symptoms other than Lyme disease, suggesting overdiagnosis in this population. Patients referred for consideration of Lyme disease for chronic symptoms deserve careful assessment for diagnoses other than Borrelia burgdorferi infection.”

Is it Lyme Disease or cervical spine instability causing your symptoms? Uncertain clinical consequences because people are not getting better.

Lyme disease is caused by the spirochete Borrelia burgdorferi, which is carried by infected ticks. This disorder has a variable clinical course and involves multiple systems, affecting the skin, nervous system, heart, and eyes. Early in the illness, many patients experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone, in one or a few locations at a time, frequently lasting only hours or days in a given location. Weeks to months later, untreated patients often have intermittent or chronic arthritis, primarily involving the large joints, especially the knees, over a period of several years.

Since the clinical course of the disorder is so varied, from mild aches and pains to debilitating memory, neurologic and heart conditions, there is no one symptom that is diagnostic for Lyme disease. For this reason, it is important for those with chronic pain and/or fatigue to get the various blood and urine tests for the condition.

Let’s look at a July 2020 paper published in the journal Clinical Infectious Diseases (1). The paper was offered to give clinical guidelines and education to doctors. You will probably see a lot of yourself in the explanation of what doctors should look for in suspected Lyme Disease patients. The doctors reading this paper are also reminded at the very opening: “Lyme disease is the most commonly reported vector-borne disease, but its clinical consequences remain uncertain.” If you are reading this article, you may be a patient who is suffering from uncertain clinical consequences because you are not getting better.

In this paper, the researchers examined studies published between 1994 and 2019. Cumulatively the symptoms in patients were:

• neck pain,
• myalgia (muscle pain),
• arthralgia (joint pain),
• paresthesia,
• sleep disorder,
• poor appetite, and
• concentration difficulties.

Listen to this part: “Patients with Lyme Disease are more likely to report nonspecific long-term sequelae (symptoms that started with the Lyme Disease), especially those experiencing persistent symptoms post-treatment.”

The problem of being successfully treated for Lyme Disease and the continuation of symptoms.

This is a frustration we often see in our cervical spine instability patients. They have been declared “recovered,”  yet symptoms persist.

In December 2017 research paper, lead by Alison W Rebman at Johns Hopkins University School of Medicine published in the journal Frontiers in Medicine (2) these observations:

“Although a physical exam and clinical laboratory tests showed few objective abnormalities, standardized symptom questionnaires revealed that patients with post-treatment Lyme Disease symptoms are highly and clinically significantly symptomatic, with poor health-related quality of life.

Post-treatment Lyme Disease symptoms patients exhibited levels of fatigue, musculoskeletal pain, sleep disturbance, and depression which were both clinically relevant and statistically significantly higher than controls.

As the prevalence of post-treatment Lyme Disease symptoms continues to rise, there will be an increased need for physician education to more effectively identify and manage post-treatment Lyme Disease symptoms as part of integrated patient care.”

A second paper published in 2021 (3), and again lead by Alison W. Rebman at Johns Hopkins University School of Medicine made many observations into the symptoms of Lyme Disease. Some of these findings included neck pain of unknown origin. Here are some brief learning points from this paper.

• Neck pain is reported with greater frequency and severity in Lyme Disease patients compared with controls and the cause is unknown.
• It is thought that neck pain is a ‘Neurologic’ factor as opposed to an arthritic factor. (Explanatory note: Cervical spine instability will eventually develop into bone spurs and boney overgrowth associated with arthritic symptoms. Neck pain may arise, without obvious arthritic MRI because of ligament laxity. A loose neck that some patients describe as unable to hold their head up or that their heads feel like a lead weight.)
• We also found that difficulty breathing and heart palpitations. This constellation of symptoms may result from a common pathway such as autonomic nervous system activation or central sensitization rather than specific cardiac or pulmonary pathology.

Case study: Treating cervical spine instability treats and alleviates symptoms attributed to Lyme Disease

In the video below, Ross Hauser, MD discusses a case history of a patient with cervical spine instability who also had a diagnosis of Lyme Disease. This particular patient had significant positive treatment results. This may not be typical for everyone. This is one case study. If you would like to discuss your symptoms, send us an email.

Summary transcript and learning points of this video:

• I regularly see people who have been diagnosed with chronic Lyme Disease symptoms. They are on many different treatment protocols. Recently we had a patient who spent seven months at another facility here in Florida to try to get over the chronic Lyme symptoms. We see many patients with long histories of Lyme Disease treatments that are not helping them restore quality of life.
• From 1994 until 2005 I ran a charity clinic in a very small town called Theses, Illinois. Right on the Kentucky, Missouri, Illinois, border. That area is a Lyme Disease belt. The Shawnee National Forest is there as well as many Lyme Disease clinics.
• During the time we offered this clinic we would see many neck pain patients who had Lyme Disease. Not only did they have neck pain but they had fatigue, brain fog, digestive problems, swallowing difficulties, ringing in their ears, tinnitus, dizziness, and facial pain. We treated these patients with simple dextrose injections, Prolotherapy injections, not to treat Lyme Disease but to help restore cervical spine stability and alleviate their neck pain. When we repaired their necks, all those symptoms went away.  Eventually, some of the Lyme Disease doctors would call me up and I would train some of them in Prolotherapy treatments.
  • Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. Prolotherapy treats cervical spine instability by regenerating and repairing damaged and weakened cervical spine ligaments. It is the cervical ligaments that hold the vertebrae in place. When the ligaments are damaged or weakened, the vertebrae slide out of place and cause a pinching, impingement, or herniation of the cervical nerves leading to the symptoms reported by neck pain and Lyme Disease patients. The treatment is demonstrated below.

At 2:30 of the video, Dr. Hauser demonstrates one case of cervical spine instability and neck pain treatments that alleviated symptoms related to the patient’s diagnosis of Lyme Disease.

If you have Lyme Disease or have been on a chronic Lyme Disease treatment program or maintenance program and these treatments have not helped you as much as you would have hoped, one possible solution may be found in the treatment of cervical spine instability.

The patient in this video is having a Digital Motion X-ray (DMX) examination. This allows the doctor and patient to visually see in real-time and real movement, problems of cervical spine and neck instability that may be leading to symptoms attributed to Lyme Disease.

• The patient in this video had terrible brain fog.
• At 2:50 of the video, Dr. Hauser demonstrates C2-C3 / C3-C4 instability. Cervical spine instability can cause restriction and compression of vital arteries and nerves that supply blood and sensation to the brain, face, and neck. Brain fog is a manifestation of cervical spine instability and is a symptom of both cervical spine instability and Lyme Disease.

Postural orthostatic tachycardia syndrome (POTS) and Lyme disease

Medical research suggests a connection between postural orthostatic tachycardia syndrome (POTS) and Lyme disease. However there is not a lot of research. In 2011 doctors at the Division of Cardiology, Department of Medicine, The University of Toledo Medical Center wrote in the publication Cardiology journal (10)
“A subgroup of patients suffering from Lyme disease may initially respond to antibiotics only to later develop a syndrome of fatigue, joint pain and cognitive dysfunction referred to as ‘post treatment Lyme disease syndrome’ . . . All of the patients in this report had suffered from LD in the past and were successfully treated with antibiotics. All patients were apparently well, until years later when they presented with fatigue, cognitive dysfunction and orthostatic intolerance. These patients were diagnosed with POTS. . .”

• Five patients (all women), aged 22-44 years, were identified for inclusion in this study.
• These patients developed symptoms of fatigue, cognitive dysfunction, orthostatic palpitations and either near syncope or frank syncope.
• Three patients were also suffering from migraine, two from anxiety and depression and one from hypertension. All patients demonstrated a good response to the employed treatment. (The employed treatment directed at POTS were manipulation, increase in dietary fluids . . .) Four of the five were able to engage in their activities of daily living and either resumed employment or returned to school.

The researchers concluded: “In an appropriate clinical setting, evaluation for POTS in patients suffering from post LD syndrome may lead to early recognition and treatment, with subsequent improvement in symptoms of orthostatic intolerance.”

POTS – Lyme Disease Treatments

In May 2014, doctors describing tow case histories of patients with Lyme Disease and POTS suggested these treatments in the Annals of noninvasive electrocardiology (11): “The treatment of Post-Lyme Disease Syndrome associated POTS most often consists of both pharmacologic and nonpharmacologic corrections of autonomic imbalance with treatment tailored towards educating the patient about avoidance of aggravating and precipitating factors. Several double‐blinded controlled trials of patients with Post-Lyme Disease Syndrome have shown no benefit after repeat antibiotic treatment and no effective therapies have been identified. ” Intravascular volume expanders (intravenous fluid intake) are used effectively in POTS as well as adrenergic antagonism (An adrenergic antagonist is a drug that inhibits the function of adrenergic receptors. and down regulates autonomic outflow), and avoidance of activities that negatively impact the patient’s quality of life.

What are we seeing in this image?

The cervical spine is intertwined with nerves and blood vessels. Cervical spine instability can compress or pinch the nerves and arteries causing a myriad of symptoms depending on how the patients moves his/her head. Cervical spine instability can cause restriction and compression of vital arteries and nerves that supply blood and sensation to the brain, face, and neck. Brain fog is a manifestation of cervical spine instability and is a symptom of both cervical spine instability and Lyme Disease.

At 2:57 of the video Dr. Hauser illustrates that in this one case, one Prolotherapy treatment into the cervical spine was sufficient enough to provide noticeable pain relief and reduction of brain fog symptoms. It should be pointed out this is not typical, patients usually will require 3 to 8 treatments to achieve long-lasting and demonstrable symptom reduction.

• The patient didn’t realize that when you have cervical instability it can affect the blood supply to the brain and it can affect the cerebral spinal fluid flow. So once this patient started to achieve cervical spine stabilization, the transformation in quality of life was unbelievable.

In this video, a demonstration of treatment is given

Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues.

This video jumps to 1:05 where the actual treatment begins. This video is a demonstration of treatment, this patient did not have Lyme Disease.

This patient is having C1-C2 areas treated. Ross Hauser, MD is giving the injections.

In our 2014 research lead by Danielle R. Steilen-Matias, MMS, PA-C and published in The Open Orthopaedics Journal (4) our research team was able to demonstrate that when the neck ligaments are injured and cause cervical spine instability (excessive movement of the cervical vertebrae), can cause a number of symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated brain fog, vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches.

This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems is not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”

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 and possibly in the case of Lyme Disease type symptoms, cervical instability symptoms.

Prolotherapy, the curve of the neck and blood flow

In this image, the progression and degeneration of the cervical spine are demonstrated, from the Lordotic curve to the Military curve to the Kyphotic curve to the “S” curve of severe osteoarthritis.

In February 2016 a paper appeared in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. (5) Here medical university researchers in Turkey made these observations:

• “The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in a close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. (Reduced blood flow into the brain).”

This is research with which we have seen empirical evidence in our over 27 years of regenerative medicine practice. To fix the problems related to the cervical spine, you need to restore the natural curvature of the neck.

In the medical journal Brain Circulation (Jan-March 2019) (6), doctors wrote up their analysis of case study patients who had cervical lordosis. They wrote that if you restored the natural curve to the neck, you could immediately increase cerebral blood flow as pressure is removed from the cerebral artery.

Here are the learning points of this research. They present a good summary of what we discussed in this article:

• Loss of lordosis of the cervical spine is associated with decreased vertebral artery hemodynamics (blood flow).
• Based on the close anatomical relationship between the cervical spine, the vertebral arteries, and cerebral vasculature, the researchers speculated that improvement in cervical hypolordosis increases collateral (from the side) cerebral artery hemodynamics and circulation.

The challenges of vertebrobasilar insufficiency 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.

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

1 Mac S, Bahia S, Simbulan F, et al. Long-Term Sequelae and Health-Related Quality of Life Associated With Lyme Disease: A Systematic Review. Clin Infect Dis. 2020;71(2):440-452. doi:10.1093/cid/ciz1158 [Google Scholar]
2 Rebman AW, Bechtold KT, Yang T, et al. The Clinical, Symptom, and Quality-of-Life Characterization of a Well-Defined Group of Patients with Posttreatment Lyme Disease Syndrome. Front Med (Lausanne). 2017;4:224. Published 2017 Dec 14. doi:10.3389/fmed.2017.00224 [Google Scholar]
3 Rebman AW, Yang T, Aucott JN. Symptom heterogeneity and patient subgroup classification among US patients with post-treatment Lyme disease: an observational study. BMJ open. 2021 Jan;11(1):e040399. [Google Scholar]
4 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]
5 Piersiala K, Akst LM, Hillel AT, Best SR. Chronic Pain Syndromes and Their Laryngeal Manifestations [published online ahead of print, 2020 Apr 30]. JAMA Otolaryngol Head Neck Surg. 2020;e200530. doi:10.1001/jamaoto.2020.0530
6 Katz EA, Katz SB, Fedorchuk CA, Lightstone DF, Banach CJ, Podoll JD. Increase in cerebral blood flow indicated by increased cerebral arterial area and pixel intensity on brain magnetic resonance angiogram following correction of cervical lordosis. Brain Circulation. 2019 Jan 1;5(1):19. [Google Scholar]
7 Baarsma ME, Claassen SA, van der Horst HE, Hovius JW, Sanders JM. Knowing the entire story–a focus group study on patient experiences with chronic Lyme-associated symptoms (chronic Lyme disease). BMC Primary Care. 2022 Dec;23(1):1-2. [Google Scholar]
8 Knudtzen FC, Jensen TG, Andersen NS, Johansen IS, Hovius JW, Skarphédinsson S. An intervention in general practice to improve the management of Lyme borreliosis in Denmark. European Journal of Public Health. 2022 Jun;32(3):436-42. [Google Scholar]
9 Kobayashi T, Higgins Y, Melia MT, Auwaerter PG. Mistaken identity: many diagnoses are frequently misattributed to Lyme disease. The American Journal of Medicine. 2022 Apr 1;135(4):503-11. [Google Scholar]
10 Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. Postural orthostatic tachycardia syndrome following Lyme disease. Cardiology journal. 2011;18(1):63-6. [Google Scholar]
11 Noyes AM, Kluger J. A tale of two syndromes: Lyme disease preceding postural orthostatic tachycardia syndrome. Annals of Noninvasive Electrocardiology. 2015 Jan;20(1):82-6. [Google Scholar]

This article was updated June 19, 2022

• Surgery
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