Similarities between Severe Tinnitus and Chronic Pain

Abstract

The symptoms and signs of severe tinnitus and chronic pain have many similarities and similar hypotheses have been presented regarding how the symptoms are generated. Pain and tinnitus have many different forms. The severity of the symptoms of both varies within wide limits, and it is not likely that all forms have the same pathology. Some individuals with severe tinnitus perceive sounds to be unpleasant or painful. This may be similar to what is known as allodynia, which is a painful sensation of normally innocuous stimulation of the skin. Many individuals with chronic pain experience a worsening of their pain from repeated stimulation (the "wind-up" phenomenon). This is similar to the increasingly unpleasant feeling from sounds that are repeated that many individuals with severe tinnitus experience. There are also similarities in the hypotheses about the generation of pain and tinnitus. Although less severe tinnitus may be generated in the ear, it is believed that severe tinnitus in many cases is caused by changes in the nervous system that occur as a result of neural plasticity. Acute pain caused by tissue injury is generated at the site of injury but chronic pain is often generated in the central nervous system, yet another similarity between chronic pain and severe tinnitus. The changes in the nervous system consist of altered synaptic efficacy including opening of dormant synapses. For pain, this is believed to occur in the wide dynamic range neurons of the spinal cord and brain stem. Less is known about the anatomic location of the changes that cause severe tinnitus but there are indications that it may be the inferior colliculus. It is also possible that other auditory systems than the classical ascending pathways may be involved in severe tinnitus.

Abbreviations: DRG = dorsal root ganglion, GABA = gamma amino butyric acid, HFS = hemifacial spasm, HTM = high threshold mechanoreceptors, IC = inferior colliculus, LTM = low threshold mechanoreceptor, TGN = trigeminal neuralgia, WDR = wide dynamic range neurons

Key Words

Chronic pain - neural plasticity - tinnitus

Publication History

Article published online:
07 April 2022

• REFERENCES

• Adams D, Wilmot T. (1982). Meniere's disease: long-term results of sympathectomy. J Laryngol Otol 96:705–710.
• Aitkin LM, Dickhaus Η, Schult DW, Zimmermann M. (1978). External nucleus of inferior colliculus: auditory and spinal somatosensory afferente and their interactions. J Neurophysiol 41:837–847.
• Aran JM, Cazals I. (1981). Electrical suppression of tinnitus. In: Ciba Foundation Symposium 85, Tinnitus. London: Pitman, 217–225.
• Bach S, Noreng MF, Thellden NU. (1988). Phantom limb pain in amputees during the first 12 months following limb amputation, after preoperative lumbar epidural blockade. Pain 33:297–301.
• Bekenstein JW, Lothman EW. (1993). Dormancy of inhibitory interneurons in a model of temporal lobe epilepsy. Science 259:97—99.
• Campbell JN, Raja SN, Meyer RA. (1988). Painful sequelae of nerve injury. In: Dubner R, Gebhart GF, Bond MR, eds. Proceedings of the Fifth World Congress on Pain. Amsterdam: Elsevier, 135–143.
• Caspary DM, Milbrandt JC, Helfert RH. (1995). Central auditory aging: GABA changes in the inferior colliculus. Exp Gerontol 30:349–360.
• Coderre TJ, Katz J, Vaccarino AL, Melzack R. (1993). Contribution to central neuroplasticity to pathological pain: review of clinical and experimental evidence. Pain 52:259–285.
• Densert O. (1974). Adrenergic innervation in the rabbit cochlea. Acta Otolaryngol (Stockh) 78:345–356.
• Densert O, Flock A. (1974). An electron-microscopic study of adrenergic innervation in the cochlea. Acta Otolaryngol 77:185–197.
• Devor M. (1988). Central changes mediating neuropathic pain. In: Dubner R, Gebhart GF, Bond MR, eds. Proceedings of the Fifth World Congress on Pain. Amsterdam: Elsevier, 114–128.
• Dubner R, Basbaum AI. (1994). Spinal dorsal horn plasticity following tissue or nerve injury. In: Wall PD, Melzack R, eds. Textbook of Pain. Edinburgh: Churchill Livingstone, 225–241.
• Feldmann H. (1971). Homolateral and contralateral masking of tinnitus by noise bands and by pure tones. Audiology 10:138–144.
• Fromm GH. (1991). Pathophysiology of trigeminal neuralgia. In: Fromm GH, Sessie BJ, eds. Trigeminal Neuralgia. Boston: Butterworth-Heinemann, 105–130.
• Garnet Passe ER. (1951). Sympathectomy in relation to Meniere's disease, nerve deafness and tinnitus. A report of 110 cases. Proc R Soc Med 44:760–772.
• Gerken GM. (1979). Temporal summation of pulsate brain stimulation in normal and deafened cats. J Acoust Soc Am 66:728–734.
• Gerken GM, Solecki JM, Boettcher FA. (1991). Temporal integration of electrical stimulation of auditory nuclei in normal hearing and hearing-impaired cat. Hear Res 53:101–112.
• Goddard GV. (1964). Amygdaloid stimulation and learning in the rat. J Comp Physiol Psychol 58:23–30.
• Jastreboff PJ. (1990). Phantom auditory perception (tinnitus): mechanisms of generation and perception. Neurosci Res 8:221–254.
• Jastreboff PJ. (1995). Tinnitus as a phantom perception: theories and clinical implications, Chapter 8. In: Vernon JA, Moller AR, eds. Mechanisms of Tinnitus. Boston: Allyn & Bacon, 73–93.
• Jastreboff PJ, Gray WC, Gold SL. (1996) Neurophysiological approach to tinnitus patients. Am J Otol 17:236–240.
• Lenarz T, Schreiner C, Snyder RL, Ernst A. (1995). Neural mechanisms of tinnitus. Chapter 10. In: Vernon JA, Moller AR, eds. Mechanisms of Tinnitus. Boston: Allyn & Bacon, 101–113.
• Lockwood AH, Salvi RJ, Coad ML, Towsley ML, Wack DS, Murphy BW. (1998). The functional neuroanatomy of tinnitus. Evidence for limbic system links and neural plasticity. Neurology 50:114–120.
• Loh L, Nathan PW. (1978). Painful peripheral states and sympathetic blocks. J Neurol Neurosurg Psychiatr 41:664–671.
• McFadden D. (1982). Tinnitus. Facts, Theories, and Treatments. Washington, DC: National Academy Press.
• Melzack R. (1990). Phantom limbs and the concept of a neuromatrix. Trends Neurosci 13:88–92.
• Melzack R. (1992). Phantom limbs. Sei Am 266:120–126.
• Melzack R, Wall PD. (1965). Pain mechanisms: a new theory. Science 150:971–979.
• Mendell LM. (1984). Modifiability of spinal synapses. Physiol Rev 64:260–324.
• Moller AR. (1987). Hemifacial spasm: ephaptic transmission or hyperexcitability of the facial motor nucleus? Exp Neurol 98:110–119.
• Moller AR. (1993). Cranial nerve dysfunction syndromes: pathophysiology of microvascular compression. In: Barrow DL, ed. Surgery of Cranial Nerves of the Posterior Fossa. Park Ridge, IL: American Association of Neurological Surgeons, 105–129.
• Moller AR. (1997a). Similarities between chronic pain and tinnitus. Am J Otol 18:577–585.
• Moller AR. (1997b). Pathophysiology of hemifacial spasm. In: Sindou M, Keravel Y, Moller AR, eds. Hemifacial Spasm. A Multidisciplinary Approach. Wien: Springer, 51–62.
• Moller AR, Jannetta PJ. (1984). On the origin of synkinesis in hemifacial spasm: results of intracranial recordings. J Neurosurg 61:569–576.
• Moller AR, Moller MB, Yokota Μ. (1992). Some forms of tinnitus may involve the extralemniscal auditory pathway. Laryngoscope 102:1165–1171.
• Moller AR, Pinkerton T. (1997). Temporal integration of pain from electrical stimulation of the skin. Neurol Res 19:481–488.
• Ochoa J. (1986). The newly recognized painful ABC syndrome: thermographic aspects. Thermology 2:65–107.
• Pollak GD, Park TJ. (1993). The effects of GABAergic inhibition on monarual response properties of neurons in the mustache bat's inferior colliculus. Hear Res 65:99–117.
• Price DD, Long S, Huitt C. (1992). Sensory testing of pathophysiological mechanisms of pain in patients with reflex sympathetic dystrophy. Pain 49:163–173.
• Roberts WJ. (1986). A hypothesis on the physiological basis for causalgia and related pains. Pain 24:297–311.
• Rouiller EM. (1997). Functional organization of the auditory system. In: Ehret G, Romand R, eds. The Central Auditory System. New York: Oxford University Press, 3–96.
• Sachs MB, Kiang NYS. (1968). Two-tone inhibition in auditory nerve fibers. J Acoust Soc Am 43:1120–1128.
• Sen CN, Moller AR. (1987). Signs of hemifacial spasm created by chronic periodic stimulation of the facial nerve in the rat. Exp Neurol 98:336–349.
• Szczepaniak WS, Moller AR. (1995). Evidence of decreased GABAergic influence on temporal integration in the inferior colliculus following acute noise exposure: a study of evoked potentials in the rat. Neurosci Lett 196:77–80.
• Szczepaniak WS, Moller AR. (1996a). Evidence of neuronal plasticity within the inferior colliculus after noise exposure: a study of evoked potentials in the rat. Electroencephalogr Clin Neurophysiol 100:158–164.
• Szczepaniak WS, Moller AR. (1996b). 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.
• Tonndorf J. (1987). The analogy between tinnitus and pain: a suggestion for a physiological basis of chronic tinnitus. Hear Res 28:271–275.
• Wall PD. (1977). The presence of ineffective synapses and circumstances which unmask them. Phil Trans R Soc Lond 278:361–372.
• Wilcox GL. (1991). Excitatory neurotransmitters and pain. In: Bond MR, Carlton JE, Woolf CJ, eds. Pain Research and Clinical Management. Vol. 4: Proceedings of the With World Congress on Pain. Amsterdam: Elsevier, 91–117.
• Willer JC. (1988). Relieving effect of TENS on painful muscle contraction produced by an impairment of reciprocal innervation: an electrophysiological analysis. Pain 32:271–274.
• Woolf CJ. (1983). Evidence for a central component of post-injury pain hypersensitivity. Nature 306:686–688.
• Woolf CJ, Thompson SWN. (1991). The induction and maintenance of central sensitization is dependent on N-methyl-D-aspartic acid receptor activation: implications for the treatment of post-injury pain hypersensitivity states. Pain 44:293–299.