Tinnitus Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Division of Psychosomatic Medicine, Medical Department, Charité-Universitätsmedizin Berlin, Berlin, Germany.
PLoS One. 2020 Jun 25;15(6):e0234807. doi: 10.1371/journal.pone.0234807. eCollection 2020.
To investigate the co-occurrence of tinnitus-related distress and pain experiences alongside psychological factors that may underlie their association.
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.
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.
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.
研究耳鸣相关困扰和疼痛体验的同时发生，并探讨可能导致它们相关联的心理因素。
慢性耳鸣患者（N=1238）完成了一个问卷，其中包括耳鸣相关困扰和情感及感觉疼痛感知。一系列简单的、平行和串行的多重中介模型检验了心理共病以及包括抑郁、感知压力和应对态度等潜在过程变量的间接影响。调节和调节中介分析检验了代偿性和非代偿性耳鸣患者之间不同的关系模式。
耳鸣相关困扰与疼痛感知之间存在显著关联。这些关联部分由大多数指定的变量中介。心理共病似乎通过对抑郁、感知压力和应对态度的影响来影响耳鸣-疼痛关联。在情感和感觉疼痛感知途径中出现了一些特定的差异。代偿性耳鸣患者在所有测量指标上的症状负担都显著更高。耳鸣代偿与耳鸣相关困扰和疼痛感知、抑郁和消极应对态度之间的关联增强有关；与大多数心理共病以及感觉但不是情感疼痛感知之间的关联增强有关。调节中介分析显示，在代偿性耳鸣患者中，抑郁和焦虑在中介情感疼痛感知，以及焦虑在中介感觉疼痛感知方面的间接效应更强。
心理构念在不同水平的耳鸣相关困扰中介导了耳鸣和疼痛相关症状的同时发生。心理治疗方法应在处理不同困扰水平的综合征患者的躯体症状群时，概念化和解决常见认知-情绪过程的个体化相互作用。
