Is Tinnitus a Chronic Pain Disorder?

Hi, I went to my family doctor general practice who is 67 years old, but at least he has an open mind: he said he did some reading and that tinnitus is the same as a chronic pain disorder, just the cochlea has been injured, and this results in loss of feedback to the cortical neurons, which no longer have nerve cells to inhibit them, so they start to fire, the same way that any other nerve injury will result in what is called neuropathic pain. As a result of his reading, he suggested that I can try carbamazepine, because this is a chronic pain medication. I already take pregabalin which is also a chronic pain med, as well as mirtazapine and Seroquel and imovane. so I am on quite a bag of medications.

My main issue is that I cannot sleep, and I need meds to get me to go to sleep, and the side effect of carbamazepine is drowsiness which for me is a good thing, because it promotes sleep. I showed up in the emergency room of the hospital 2 months ago after I had had some noisy dental work done, which resulted in a very bad spike of tinnitus, due to about 5 days of absolutely no sleep and just going nuts, feeling that I would be probably in a pine box very soon, or something drastic.
They prescribed imovane for me 15mg at bedtime, which at least put me to sleep, and then with sleep my tinnitus gradually started to improve.

I started taking the carbamazepine 2 days ago. the first night it seemed to help me, but yesterday I had some few seconds of noise, and it spiked my tinnitus again so I am in the suffering mode again.

I am so happy that my doctor has been doing his own reading and research. Question: is he on the right track by calling this a chronic pain disorder, and is it good to treat tinnitus like chronic pain - and should I be optimistic.

 

I think no one really knows what Tinnitus is, that's a huge part of the problem, why there isn't yet a cure. So noone can really tell you if you're on the right track with the medication and the conic pain theory. But as you said, you are lucky to have a doctor that is willing to try things instead of just telling you "to live with it". If it doesn't work, you can always stop taking it or try something else.

 

Basically it is pain, but the ears way of telling pain is emitting a sound signal.

 

I have been thinking that chronic pain and tinnitus have a lot of things in common. As you have written, they both start with a real injury to an organ or nerve. A pain or tinnitus signal is transmitted to the brain. After a while the original causes ceases to exist (the injury heals, hearing gets better), but in tinnitus or chronic pain sufferers changes in the brain happens and connections are made the cause that signal to continue.

I'm not a physician and cannot say which areas of the brain are affected and whether they are the same for both conditions. The only thing I know is that they currently doctors don't seem to be able to cure chronic pain, they only have treatments that offer some improvement. Some treatments offered for chronic pain sufferers are also recommended for tinnitus patients f.e. cognitive behavioral therapy. Cognitive behavioral therapy is also recommended for longtime sleeping problems.

I'm not sure if it is currently totally resolved which areas of the brain are affected and how they are affected. Otherwise one would think that researchers might have already come up with ideas how to reverse those maladaptive changes in the brain.

 

If tinnitus is like chronic pain that this would help to explain why it may get worse over time - because of an effect called 'recruitment' - where normally firing neurones start to fire spasmodically and erratically because they are being influenced by nearby damaged neurones. That it the theory behind using anti-seizure membrane-stabilizing drugs such as gabapentin, pregabelin, carbamazepine, valproic acid and lamotrigine in chronic pain. These are certainly all worth trying - especially carbamazepine or valproic acid (Epival) as they have blood levels that can guide dosages.

 

I recall that this medication works very well for something called typewriter tinnitus.

Typewriter tinnitus: a car... [ORL J Otorhinolaryngol Relat Spec. 2006] - PubMed - NCBI

 

Bravo for your doctor! Even if he is not on the right path, the fact that the old dog is trying to teach himself some new tricks is laudable and rare.

 

Thanks Dr. Ancill for the explanation. Aren't you a doctor yourself? It is good to have someone here who has studied these things and can tell us how right or wrong we are with our theories. Except with tinnitus there are many things that even physicians don't know yet

I like your theory about why tinnitus could worsen over time. I feel I agree with that more. There are still some people out there who are trying to tell that tinnitus or tinnitus worsening is just a psychological problem. I feel that stress does play a part in tinnitus and the perception of it, but there has to be a neurological problem as well.

 

Is anybody having any relief, as in percieved lower T, while on these drugs?

 

the carbamazepine is helping me sleep and deal with the tinnitus - otherwise I have serious sleep issues, so I can function better during the day if I have proper sleep. I have a feeling that cannabinoid type med would also help me, but I have absolutely no access to that type of thing. There is a cannabis strain with high CBD content and not psychoactive, I have a feeling it would help me, but as I said, I have absolutely no access to this.

I have been looking into music therapy, and my daughter is preparing an MP3 file of "notched" appropriate tracks of Enya - I find that the Enya tracks are suitable for "masking ".

 

Which strain are you talking about and why can't we have access to it?
What about CBD gum:
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It's called Charlottes Web, and they test me at work for cannabis, so I can't get it until I retire.
Charlotte's Web Marijuana Reviews - Leafly