The International Tinnitus Journal

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The International Tinnitus Journal

Official Journal of the Neurootological and Equilibriometric Society
Official Journal of the Brazil Federal District Otorhinolaryngologist Society

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ISSN: 0946-5448

Volume 25, Issue 1 / June 2021

Research Article Pages:46-50

Is Pain Harder to Withstand than Tinnitus?

Authors: Henk M Koning, Bas C ter Meulen

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Abstract

Objectives: The object of the study was to compare the perception of tinnitus with the perception of pain and to find specific factors that could influence the perception of both pain and tinnitus. Design: A retrospective analysis of 124 patients with tinnitus as main complaint and 300 patients with cervical pain as main complaint who visited our clinic in a two-year period. Results: This study indicates that it is harder to withstand cervical pain than tinnitus with a higher prevalence of fatigue and impaired work performance in cervical pain patients. Our analyses highlight the importance of fatigue as a potential mediator of the deleterious effects of pain and tinnitus on individual functioning. Female gender and the presence of cervical pain makes patients more accessible for fatigue. Tolerance against tinnitus depends on the perceived maximal intensity of tinnitus, but also of the presence of cervical pain. Cervical pain may reinforce the irritating awareness of tinnitus. Conclusions: Tinnitus and chronic pain are related to structural and functional brain changes that show a striking overlap between both conditions. The tolerance, the ability to withstand the “unpleasantness” of the percept, for tinnitus and pain depends on the perceived intensity of the sensation. However, the perceived intensity of pain provoked annoyance earlier compared to the perceived intensity of tinnitus. Cervical pain may reinforce and maintain the negative awareness of tinnitus. For a better withstanding of tinnitus, we advise to reduce the perceived maximal intensity of tinnitus and to treat cervical pain and fatigue

Keywords: Tinnitus, cervical pain, tolerance, perception, fatigue, frontostratial circuit.


Keywords

Tinnitus, cervical pain, tolerance, perception, fatigue, frontostratial circuit.

Introduction

Phantom perception is the awareness of a percept without an external stimulus [1-3]. The vast majority of sensory phantoms are in the somatosensory (phantom pain) and auditory (tinnitus) modalities. Both pain and tinnitus have sensory (discriminative) and affective (the “unpleasantness”) dimensions and can induce an avoidance behavior [1]. The perception of pain and tinnitus can be objectivated by the following measures: perceived intensity and tolerance (i.e. the ability to withstand the “unpleasantness” of the percept) [3-5]. The perceived intensity can be measured by the Visual Analog Scale (VAS) and tolerance can be estimated by self-report of the patient [6-8]. There are meaningful dissimilarities between tinnitus and chronic pain [9]. Pain is a vital protective function and carries an inherently negative feeling [10]. Auditory signals may only become bothersome if the sensation last for extended periods of time [9]. Therefore, the tolerance for pain and for tinnitus may differ. The aim of the study was to compare the perception of tinnitus with that of pain and to find specific factors that could influence the perception of both pain and tinnitus.

Materials and Methods

The Medical Ethics Committees United (Nieuwegein, the Netherlands) agreed this observational retrospective study (W20.131, June 10, 2020).

Subjects

All patients who came forward to Pain Clinic De Bilt, The Netherlands, for cervical pain or for tinnitus in a two years period (1/1/2018 - 31/12/2019) took part in the study. There were no exclusion criteria. The work-up of patients being a standardized clinical history, the perceived intensity of pain or tinnitus, and a standardized questionnaire for the psychosocial status. The minimal, maximal and mean intensity of tinnitus or pain were measured by the Visual Analogue Scale (VAS). A standardized questionnaire for the psychosocial consequences of tinnitus or pain included the following questions (“Are you good awake in the morning?”, “Is your concentration disturbed?”, “Is it hard to withstand your tinnitus/pain?”, “Are you feeling depressed?”, “Are you having fear”, and “Are you feeling fatigue?”, “Is your work performance impaired?”). Possible answers for each question were none, slight, moderate, or always.

Data Assessment

Data obtained from these patients are age, sex, the minimal, maximal and mean intensity of tinnitus or pain measured by the VAS, and the results of the psychosocial questionnaire. The VAS of tinnitus or pain are 10-cm lines between at the left end by “no tinnitus or pain” and at the right end by “unbearable tinnitus or pain”. The patient indicate with marks the level of the mean, minimal and maximal perceived intensity of his or her tinnitus or pain. The score is measured by the distance (millimetre) on the 10-cm line between the “no tinnitus or pain” anchor and the patient’s mark. The questions of the questionnaire for the psychosocial consequences of tinnitus or pain were rated with none (0), slight (1), moderate (2), or good (3). A score of 2 or more indicates for withstanding tinnitus or pain, sleep, concentration, depression, fear, fatigue, and work performance as disturbed.

Statistical Methods

Statistical analysis was executed with Minitab 18 (Minitab Inc., State College, PA, USA). Student’s t-test was employed for continuous variables and χ2 test for dichotomous variables. Discriminant analysis was used in order to evaluate the correlation of the intensity of tinnitus or cervical pain with the feeling that the sensation is hard to withstand and with fatigue. A value of P less than 0.05 was statistically significant.

Results

In two year time, 124 patients attended our clinic with tinnitus and 300 patients with cervical pain as main complaint. In Table 1, we compared both groups with each other. Cervical pain begins at a younger age and it affects more female (M:F-ratio of 0.5 vs 1.3) , compared to tinnitus patients. Although the perceived mean and minimal intensity of cervical pain was less compared to that of tinnitus, it was harder to withstand cervical pain than tinnitus There were more fatigue and more impaired work performance in cervical pain patients compared to tinnitus patients. Multivariate statistical analysis indicated that the perceived maximal intensity of the sensation together with the sensation itself (tinnitus or pain) was statistically significant related to the feeling that the sensation is hard to withstand. Discriminant analysis was used in order to evaluate the correlation of the maximal intensity of the sensation with the prevalence of the feeling that the sensation is hard to withstand for tinnitus and for cervical pain (Figure 1). If the VAS of the intensity of maximal cervical pain is higher than 77 millimetre or if the VAS of the intensity of the maximal tinnitus is higher than 93 millimetres, the prevalence of the feeling that it is hard to withstand the sensation increases from 45% to 72%. (hence nP/Pi+,0).

  Cervical pain as main complaint (n=300) Tinnitus as main complaint (n=124) P-value  
  Prev. Mean    SEM Prev. Mean   SEM    
Age at the start of the complaint (year)   41      1.4   47     1.3 0.001 S
Gender (Male): 32%   57%   0.000 S
Perceived intensity of the sensation (mm):            
- Mean   57      1.9   65     2.4 0.016 S
- Minimal   32      1.8   41     2.9 0.007 S
- Maximal   85      1.1   82     1.9 0.09  
- Variation (Maximal – Minimal)   56      2.0   42     2.9 0.000 S
Is it hard to resist the sensation? (Yes): 66%   50%   0.009 S
Fatigue (Yes) 77%   63%   0.012 S
Disturbed sleep (Yes) 67%   60%   0.263  
Impaired work performance (Yes) 72%   54%   0.002 S
Disturbed concentration (Yes) 54%   65%   0.093  
Feeling depressed (Yes) 44%   41%   0.565  
Fear (Yes) 19%   28%   0.061  

 

*Corresponding Author:

Henk M Koning, Department of Pain therapy, Pain Clinic De Bilt, De Bilt, The Netherlands, E-mail: [email protected] Phone: +31302040753

 

Paper submitted on January 25, 2021; and Accepted on February 10, 2021

Citation: Henk M Koning,Bas C ter Meulen. Is Pain Harder To Withstand Than Tinnitus?. International Tinnitus Journal. 2021;25(1):46-50.

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