Detailed guides to painful problems, treatments & more

Tinnitus, pain, and the Zen of Suffering

 •  • by Paul Ingraham
Get posts in your inbox:
Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Tomasz Szynalski has a blog charmingly named “Hope This Helps.” For instance, he hopes he can help with some tinnitus tips:

As I’ve spent a lot of time reading and thinking about tinnitus, I want to share some tips that helped me get over the initial shock and go back to living normally. Much of the advice in this FAQ is based on what I’ve read about Tinnitus Retraining Therapy (TRT), the leading clinically proven tinnitus treatment.

Tinnitus is an interestingly “pain-adjacent” condition, much like globus pharyngeus, the maddening illusion of a lump in your throat, like a stuck pill. Chronic pain overlaps with “sensory disturbance” conditions like globus and tinnitus, and much of what Tomasz writes is helpful in other contexts — such as chronic pain patients trying to learn to cope with and adapt to their spurious, hyperbolic sensations. Much of the problem with tinnitus is not the noise itself, but what we do with it:

In neurological terms, the auditory stimulus leads to a stress response. You find the sound disturbing, you can’t think about anything else, your heart is racing, you can’t fall asleep at night — all these problems are not due to tinnitus; they are due to your emotional reaction to tinnitus.

Pain is inherently a prima donna, demanding attention by its very nature. The only thing worse than an obnoxiously demanding sensation is an obnoxiously demanding sensation plus an excessive “stress response.” Neither are easy to change, but arguably the stress response is more tractable — or at least an extra way to work on a hard problem. If you can’t make the pain go away, work on not reacting to it, which is also good.

My wife, as it happens, is an amazing example of this. As the victim of an extremely serious accident in 2010 — several nasty fractures, including her back — she now lives with quite a lot of chronic pain, and she is fascinatingly good at not letting it rattle her. Many skills and characteristics seem to go into this superpower: some natural stoicism, some irrepressible joie de vivre, probably even some “denial.” She often seems to just lie about it: “No, I’m not in pain.” Translation: “Of course I’m in pain, but I’m not going to give it one damn second of air time.” However she does it, she really seems like a master of the Zen of Suffering. If she had mild to moderate tinnitus, I wonder if she would even mention it.

She probably would if it was bad enough though…

The Zen of Suffering is a nice idea and all, but it’s not always a realistic option

An old friend of mine has suffered from tinnitus for two decades, diligently working on her coping skills the whole time. But recently it got a lot worse. Over the course of a few days, the severity surged well beyond any rough patch she’s ever had before. I asked her how she feels about the idea of “managing the stress response” in the midst of this crisis. She replied:

Really, I need to use those old worn out drill bits and tools on this fresh new crazy unprecedented issue? Let’s figure out why the noise got so intense first. I need some medical attention!

When sensation is blaring too loudly enough, it’s an emergency, and the priority is to try to solve the problem, not “cope” with it. If someone is bleeding to death, you don’t tell them that “the only thing worse than being injured is also freaking out about it.” It’s not technically wrong (freaking out is rarely helpful), but it’s not where the focus is, especially at first.

If extreme pain or tinnitus persists, however, the challenge of coping slowly becomes central again — existentially unavoidable, no matter how brutally hard it is.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher