Tinnitus-related distress and pain perceptions in patients with chronic tinnitus - Do psychological factors constitute a link?

Abstract

Objective: To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.

Method: Patients with chronic tinnitus (N = 1238) completed a questionnaire battery examining tinnitus-related distress and affective and sensory pain perceptions. A series of simple, parallel- and serial multiple mediator models examined indirect effects of psychological comorbidities as well as -process variables including depressivity, perceived stress and coping attitudes. Moderator and moderated mediation analyses examined differential relational patterns in patients with decompensated vs. compensated tinnitus.

Results: There were significant associations between tinnitus-related distress and pain perceptions. These were partially mediated by most specified variables. Psychological comorbidities appeared to influence tinnitus-pain associations through their impact on depressivity, perceived stress, and coping attitudes. Some specific differences in affective vs. sensory pain perception pathways emerged. Patients with decompensated tinnitus yielded significantly higher symptom burden across all measured indices. Tinnitus decompensation was associated with heightened associations between [1] tinnitus-related distress and pain perceptions, depressivity and negative coping attitudes; and [2] most psychological comorbidities and sensory, but not affective pain perception. Moderated mediation analyses revealed stronger indirect effects of depressivity and anxiety in mediating affective-, and anxiety in mediating sensory pain perception in patients with decompensated tinnitus.

Conclusion: Psychological constructs mediate the co-occurrence of tinnitus- and pain-related symptoms across different levels of tinnitus-related distress. Psychological treatment approaches should conceptualize and address individualised interactions of common cognitive-emotional processes in addressing psychosomatic symptom clusters across syndromatic patients with varying distress levels.

Fig 1. Conceptual diagrams of the specified models.

Panel a: Simple and parallel multiple mediator models specifying tinnitus-related distress as independent, the putative mediators’ total (left) or subscale scores (right) as mediating, and affective or sensory pain perception as dependent variables. Panel b: Serial multiple mediator models specifying tinnitus-related distress as independent, psychological ‘comorbidities’ as first-level mediating variables, psychological process variables (depressivity, perceived stress, and coping attitudes) as second-level mediating variables, and affective or sensory pain perception as dependent variables. Panel c: Simple moderator models investigating the effect of tinnitus decompensation vs. compensation (W) on paths c (left), a (middle), or b (right). Panel d: Moderated mediation model investigating the effect of tinnitus decompensation vs. compensation on ab.

Fig 2. Graphical illustration of significant indirect effects.

Black box frames indicate significant positive, dotted box frames significant negative and greyed-out boxes non-significant indirect effects. Panel a: Results of the simple mediator models for affective (left) or sensory pain perception (right). Panel b: Results of the parallel multiple mediator models for PSQ- (upper row) and ISR subscales (lower row) mediating affective (left) or sensory pain perception (right). Panel c: Results of the serial multiple mediator models that examine the effects of shared psychological process variables across psychological ‘comorbidities” on affective (upper row) or sensory pain perception (lower row). Reading example for upper row: the indirect effect of tinnitus-related distress [TQ] on affective pain perception [SES_A] through psychological comorbidities [ISR] is explained by the latters impact on depressivity [ADS], but not perceived stress [PSQ, T, W, reduced J, D] or coping attitudes [reduced SE, Opt, heightened Pes]. TQ = Tinnitus Questionnaire–German version total score, SES_A = Affective Pain Perception Scale: SES_S = Sensory Pain Perception Scale, ISR = ICD-10 Symptom Rating total score, DS = depressive syndrome, AS = anxiety-related syndrome, OS = obsessive-compulsive syndrome, SS = somatoform syndrome, ES = eating-related syndrome, Sup = supplementary scale, ADS = Center for Epidemiological Studies Depression Scale total score, PSQ = Perceived Stress Questionnaire total score, T = tension, W = worries, J = joy, D = demands, SE = Self-efficacy scale, Opt = Optimism scale; Pes = Pessimism scale. Significance level set at p < .05.

Fig 3. Graphical illustration of simple moderation effects.

De/Co indicates the specification of tinnitus decompensation vs. compensation as a putative moderator of paths c (left), a (middle) and b (right upper row: affective pain perception; lower row: sensory pain perception). Continuous black box frames indicate that respective effects are stronger in patients with decompensated vs. compensated tinnitus, dotted box frames the opposite. Greyed out boxes indicate non-moderated effects. TQ = Tinnitus Questionnaire–German version total score, SES_A = Affective Pain Perception Scale: SES_S = Sensory Pain Perception Scale, ADS = Center for Epidemiological Studies Depression Scale total score, PSQ = Perceived Stress Questionnaire total score, T = tension, W = worries, J = joy, D = demands, ISR = ICD-10 Symptom Rating total score, DS = depressive syndrome, AS = anxiety-related syndrome, OS = obsessive-compulsive syndrome, SS = somatoform syndrome, ES = eating-related syndrome, Sup = supplementary scale, SE = Self-efficacy scale, Opt = Optimism scale; Pes = Pessimism scale. Significance levels were set at p < .05.

Fig 4. Graphical illustration of moderated mediation models for affective (left) and sensory pain perception (right).

De/Co indicates the specification of tinnitus decompensation vs. compensation as a putative moderator of the indirect effects of tinnitus-related distress on affective or sensory pain perceptions through the specified process variables. Continuous black box frames indicate that respective indirect effects are stronger in patients with decompensated vs. compensated tinnitus. Greyed out boxes indicate non-moderated indirect effects. TQ = Tinnitus Questionnaire–German version total score, SES_A = Affective Pain Perception Scale: SES_S = Sensory Pain Perception Scale, ADS = Center for Epidemiological Studies Depression Scale total score, PSQ = Perceived Stress Questionnaire total score, T = tension, W = worries, J = joy, ISR = ICD-10 Symptom Rating total score, DS = depressive syndrome, AS = anxiety-related syndrome, OS = obsessive-compulsive syndrome, SS = somatoform syndrome, ES = eating-related syndrome, Sup = supplementary scale, SE = Self-efficacy scale, Opt = Optimism scale; Pes = Pessimism scale. Significance level set at p < .05.