Similarities Between Tinnitus and Pain
Both pain and tinnitus have many different forms.
Tinnitus and central neuropathic pain are phantom sensations similar to the phantom limb symptoms that occur without any physical stimulation of sensory receptors.
Tinnitus and neuropathic pain are typical examples of “plasticity disorders” where the symptoms are caused by plastic changes that are not beneficial to an individual person.
Central neuropathic pain and tinnitus have no physical signs.
The severity of pain and tinnitus are difficult to assess quantitatively even under laboratory circumstances. Only the patients’ own perception is a true measure of the severity of central pain and subjective tinnitus.
The perception of pain and tinnitus is affected by many factors such as actual circumstances, expectation, stress, and a person’s emotional state.
Many forms of pain are best described as suffering; the same is the case for severe subjective tinnitus.
Pain and tinnitus can have strong emotional components, it often prevents or disturbs sleep, and it can interfere with or prevent intellectual work.
It is difficult to get reliable data on epidemiology of tinnitus and central neuropathic pain because of their subjective nature and large variability.
Activation of neural plasticity is involved in causing and maintaining central neuropathic pain and many forms of subjective tinnitus.
The nervous system is the site of the anomalies that cause central neuropathic pain and many forms of tinnitus. Both tinnitus and pain involve a cascade of neural structures.
The pathology of the nervous system in some forms of central neuropathic pain is stable in the pathologic state. It may be similar for some forms of tinnitus.
Pain that is perceived as escapable uses a different part of the periaquaductal gray than pain that is perceived as inescapable. It is not known if tinnitus also has such distinctions.
Severe tinnitus is often accompanied by hyperacusis (lowered tolerance to sounds); pain may be accompanied by allodynia (pain from normally innocuous touch of the skin) hyperpathia (exaggerated reaction to acute pain), and hypersensitivity (lowered threshold for painful stimulation).
Some forms of tinnitus and pain can be modulated by electrical stimulation of the skin.
Electrical stimulation of several cortical structures can modulate both pain and tinnitus.
The sympathetic nervous system can modulate pain and some forms of tinnitus.
KeywordsTinnitus Pain Central neuropathic pain Hyperacusis Allodynia
Dorsal cochlear nucleus
Nucleus of the tractus solitaries
Transderm electrical nerve stimulation
Ventral cochlear nucleus
Wide dynamic range neurons
- 3.Møller AR (2000) Similarities between severe tinnitus and chronic pain. J Amer Acad Audiol 11:115–24.Google Scholar
- 6.Møller AR (2008) Neural Plasticity: for Good and Bad. Progress of Theoretical Physics Supplement No 173:48–65.Google Scholar
- 10.McMahon SB and M Koltzenburg, eds. Wall and Melzak’s Textbook of Pain. 5th ed. 2006, Elsevier, Churchill, Livingstone: Amsterdam.Google Scholar
- 11.Langguth B, G Hajak, T Kleinjung et al (2007) Tinnitus: pathophysiology and treatment, progress in brain research. Prog Brain Res 166:1–542.Google Scholar
- 20.Coles RAA and SA Sook (1998) Hyperacusis and phonophobia in hyperacusic and nonhyperacusic subjects. Br J Audiol 22:228.Google Scholar
- 21.Ruth R and JI Hall, (1999) Patterns of audiologic findings for tinnitus patients, in Proceedings Sixth International Tinnitus Seminar, J Hazell, Editor. The Tinnitus and Hyperacusis Center: London. 442–5.Google Scholar
- 22.Hamill-Ruth RJ, RA Ruth, DC Castain et al (2000) Mangement of Tinnitus and Hyperacusis using a Multidiciplinary Pain Model. Am Pain Soc Bull.Google Scholar
- 24.Nölle C, I Todt, R Seidl et al (2004) Pathophysiological changes of the central auditory pathway after blunt trauma of the head. J Neurotrauma 21:251–8.Google Scholar
- 26.Møller AR (2006) Intraoperative Neurophysiologic Monitoring, 2nd Edition. Totowa, New Jersey: Humana Press Inc.Google Scholar
- 29.Quaranta A, V Sallustio and A Scaringi, (1999) Cochlear function in ears with vestibular schwannomas., in Third International Conference on Acoustic Neurinoma and other CPA Tumors, M Sanna et al, Editors. Monduzzi Editore: Rome, Italy. 43–50.Google Scholar
- 30.Szczepaniak WS and AR Møller (1996) Effects of (−)-baclofen, clonazepam, and diazepam on tone exposure-induced hyperexcitability of the inferior colliculus in the rat: possible therapeutic implications for pharmacological management of tinnitus and hyperacusis. Hear Res 97:46–53.PubMedGoogle Scholar
- 31.Densert O (1974) Adrenergic innervation in the rabbit cochlea. Acta Otolaryngol. (Stockh.) 78:345–56.Google Scholar
- 32.Passe EG (1951) Sympathectomy in relation to Ménière’s disease, nerve deafness and tinnitus. A report of 110 cases. Proc Roy Soc Med 44:760–72.Google Scholar
- 33.Baron R, (2006) Complex regional pain syndromes, in Wall and Melzack’s Textbook of Pain, SB McMahon and M Koltzenburg, Editors. Elsevier: Amsterdam. 1011–27.Google Scholar
- 34.Doubell TP, RJ Mannion and CJ Woolf, (1999) The dorsal horn: state-dependent sensory processing, plasticity and the generation of pain, in Handbook of Pain, PD Wall and R Melzack, Editors. Churchill Livingstone: Edinburgh. 165–81.Google Scholar
- 36.Brodal A (2004) The central nervous system third edition. New York: Oxford University Press.Google Scholar
- 37.Dubner R and AI Basbaum, (1994) Spinal dorsal horn plasticity following tissue or nerve injury, in Textbook of Pain, PD Wall and R Melzack, Editors. Edinburgh: Churchill Livinstone. 225–41.Google Scholar
- 38.Wall PD (1977) The presence of ineffective synapses and circumstances which unmask them. Phil. Trans. Royal Soc. (Lond.) 278:361–72.Google Scholar
- 46.Aitkin LM (1986) The auditory midbrain, structure and function in the central auditory pathway. Clifton, NJ: Humana Press.Google Scholar
- 48.Rakel B and R Frantz (2003) Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain Symptom Manage 4:455–64.Google Scholar
- 49.Cooney WP (1997) Electrical stimulation and the treatment of complex regional pain syndromes of the upper extremity. Hand Clin. 13.Google Scholar
- 52.Levine RA, EC Nam, Y Oron et al, (2007) Evidence for a tinnitus subgroup responsive to somatosensory based treatment modalities, in Tinnitus: Pathophysiology and Treatment, Progress in Brain Research, B Langguth et al, Editors. Elsevier: Amsterdam. 195–207.Google Scholar
- 55.Morgan DH (1973) Temporomandbular joint surgery. Correction of pain, tinnitus, and vertigo. Den Radiogr Photogr 46:27–46.Google Scholar
- 63.Kaltenbach JA (2007) The dorsal cochlear nucleus as a contributor to tinnitus: mechanisms underlying the induction of hyperactivity, in Tinnitus: Pathophysiology and Treatment, Progress in Brain Research, B Langguth et al, Editors. Elevier: Amsterdam. 89–106.Google Scholar
- 64.Møller AR (2006) Hearing: Anatomy, physiology, and disorders of the auditory system, 2nd Ed. Amsterdam: Academic Press.Google Scholar