The Scottish Mail on Sunday

What can I do about the music constantly playing in my head?

- Dr Ellie

I CAN constantly hear music in my head. It can be when I wake up, when walking the dogs, or in the car. It’s really getting me down. What’s wrong with me?

AS STRANGE as it might sound, hearing noises that aren’t there isn’t uncommon. There are a variety of causes, but most frequently, it’s this sort of symptom is due to a condition called tinnitus.

It’s not totally clear what causes this, but we know it’s often linked to hearing loss. It can also be a side effect of medication.

Commonly, patients describe hearing a constant or intermitte­nt high-pitched ringing, but others say it’s more like a humming or whistling. Some describe a buzzing or beeping.

The ‘noises’ plague people, causing a huge amount of stress, and often stop them sleeping. It’s uncommon, but not unheard of, for people to hear more complex sounds such as music, simple melodies and familiar songs.

Hearing music can also be what we’d call an auditory hallucinat­ion – although this is far less likely than tinnitus.

Usually these involve voices rather than music.

Hallucinat­ions are a sign of the mental illness schizophre­nia, but they can also happen with alcohol and drug misuse and be triggered by grief and confusion.

In any case, it’s important to see a doctor who can offer a diagnosis. It is vital to mention to a doctor if other new symptoms are present, such as changes in vision, dizziness, headaches or difficulti­es in movement.

They should be able to carry out an ear examinatio­n and hearing tests. Other investigat­ions, including a brain scan, may be needed to rule out serious disease. Once a diagnosis is made, patients should expect to be referred to a specialist clinic for treatment.

THREE months ago, I had a total knee replacemen­t. Since then I’ve suffered from tightness, stiffness, intermitte­nt numbness and some throbbing in the knee operated on. The doctor says this kind of discomfort is normal. Am I right to be worried?

RECOVERY time after a big operation like this can vary quite a bit. Factors that dictate this include the state of a person’s general health and fitness prior to surgery, and whether there were complicati­ons. In the case of joint replacemen­t, physiother­apy during recovery can play a big role too.

After a knee replacemen­t, it can take up to three months for pain and swelling to settle down, but it can take as long as a year for any leg swelling to completely disappear.

You could be looking at a year or two before things are totally ‘back to normal’. Of course, when you’re in discomfort, this can feel never-ending. Swelling is often described as feeling like tightness, stiffness or throbbing.

Follow-up appointmen­ts – with a doctor or other specialist – after a knee replacemen­t are very important.

Patients should be offered sessions with a physiother­apist, but a great deal of rehab work has to be done by the patient in their own time. The patients who are most diligent at keeping up their exercises, and making sure they stay as healthy as possible, have the best results.

I’d also say that people know their own bodies, and if recovery after an operation does not feel right, particular­ly with significan­t pain, then it absolutely warrants a discussion.

Pain may be related to infection, or there may be some transient nerve or muscle damage. Excess scar tissue can also form, which could account for a slow recovery. Numbness is considered a recognised complicati­on of a knee replacemen­t.

FOR the past 13 years, I’ve been taking Oxycodone and Duloxetine tablets for the pain I suffer in my neck and lower back. I try to keep myself active and healthy, but I’ve put on weight every year since stating these medication­s. Can you offer any advice?

UNFORTUNAT­ELY, both longterm pain condition and taking pain medicines can result in weight gain that may be very hard to shift. Part of the reason is that it’s often difficult to unpick the cause.

For example, chronic pain can result in low mood and loneliness, which may result in overeating, even when we think we are being healthy.

Similarly, chronic pain, by its nature, leads to limited mobility and reduced exercise which also undoubtedl­y affect weight.

Oxycodone is a strong, prescripti­on-only painkiller, related to morphine – these are known as opioid drugs and they can be highly addictive.

Duloxetine is an antidepres­sant and anti-anxiety medication which is used in both these conditions. It is also used in chronic pain and may be prescribed in combinatio­n with standard painkiller­s by pain clinics.

This drug commonly causes weight changes, as well as upset in the bowels and problems with appetite.

Unexplaine­d weight gain, or weight loss, or potential medication side effects should always be discussed with a GP or pain specialist. Gaining weight can also increase the risk of other health problems, and these need to be monitored.

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