Chronic Pain

As a chronic pain sufferer for many years, I have the dubious distinction of having a rather privileged insight into the plight of these unfortunate victims.

Since most of our TMD cases are chronic in nature (with recurring acute symptoms), those of us engaged in a significant focus of TMD harbor a large chronic pain population in our practice.

Chronic pain is insidious in its development, and pervasive in its growth, casting a shadow over the victim's life before its presence is even recognized. Not only the victim's persona, but the victim's total environment and every relationship within is affected.

The nexus of chronic pain is a metamorphosis from butterfly to grub, from chronic pain patient to chronic pain patient in distress and beyond. This voyage is too often unnecessary but has become almost endemic in TMD consequent to an absence of informed intervention.

The victim's wretched existence is the same regardless of the origin of his or her pain.

These changes will be inevitable over time regardless of the victim's degree of will power, I.Q., or pain threshold level at the outset. The insidiousness of the changes concomitant with the victim's withdrawal from all social contact makes it difficult, if not impossible, for timely perception of danger signals along the way.

This is not the time for MORE medications.

Chronic pain victims have in all probability not only been over medicated prior to arrival at your office, but also many of their current meds will be counter-productive with each other.

Mis-use and overuse of medications has already obfuscated original tissue compromises and dysfunctions making it more difficult to determine etiologies; this is not the time to add to this problem! This is a time for clearing muddied waters so you may determine essential diagnostics and ultimately format an effective treatment plan. Chronic pain victims can, do, and will tolerate a modicum of daily pain and still function; thus, any significant reduction in the daily level of pain is most appreciated! What most chronic pain victims will not accept is a reduction in that pain level at the expense of their mental acuity and awareness. People generally do not wish to function in a fog!

TRANSLATION: Normal people do not inherently appreciate being transformed into toxic waste dumps by an ongoing continuum of medications forcing them to function in a fog!

Many years ago, l began including in my chronic pain patient reports, the following:

Not many years ago, "chronic pain" was not even recognized by the American Medical Association Guides to Permanent Physical Impairment. However, today Chronic Pain is recognized as an entity unto itself.

Interfacing with the Chronic Pain Patient visage is not a pleasant experience. Victims suffering from chronic pain are not likable people; not only relatives, friends, acquaintances and strangers, but even clinicians are "turned off" by the whining complainant. Clinicians with limited time schedules are very much inclined to quickly write a prescription to avoid having to listen to their woes again and again and again.

As a result, this entity was relegated to the same disposal heap as some forms of mental illness (also not pleasant to encounter) and other entities which did not conveniently fit into the schedules of doctors, attorneys and friends or relatives. Little resource was assigned to the study of this entity, and these victims were shoved under the rug of society.

Today, with gratitude to a handful of people who have devoted their careers to the study of this entity, we are now privy to the ravages and ramifications it has upon these victims. Furthermore, when given its proper priority in treatment planning, these victims can often be reclaimed so as to reassume their role in society which had been so unfairly taken from them.

A victim suffering from pain as a result of unresolved soft tissue injury is a chronic pain patient. If this pain is not resolved quickly (i.e., days or weeks), but drags on for six months or more, this patient becomes a chronic pain patient in distress with the following problems as recognized and documented in both medical and dental literature:

the longer the injuries are left unresolved, the more difficult diagnosis and treatment become;

the patient experiences a reduction in pain tolerance;

the patient experiences a vicious self-feeding cycle of frustration, despondency and anxiety, often leading to clinical depression requiring supportive therapy;

symptoms and patient complaints will increase exponentially and "hop-scotch" around on good days and bad days;

the patient will gradually withdraw from friends and acquaintances, family and spouse, hobbies, and even from the workplace, concentrating solely on tolerating their multi-tiered levels of pain;

consortium with a spouse or companion is always affected, as even routine tasks such as eating and sleeping are made more awkward and difficult to pursue.

The face is the mirror of our very existence; it reflects all inner feelings, whether they be restful or in turmoil, as we interface with others in every daily endeavor. Smiling, talking, laughing, frowning, worrying, whatever our inner feelings happen to be is ultimately displayed for all to share for good or bad.

Our mouths are used to speak, eat, love, and to communicate with the nuances of expression every feeling imaginable.

Both the face and the mouth are at the mercy of the function or dysfunction of the TMJoint; the TMJoint is the primary joint used to sustain life, and when functioning properly, it provides for the enjoyment of life more than any other joint.

When dysfunction of this TMJoint is accompanied by constant pain or discomfort, everything is affected. There are no time-outs; our very existence becomes totally focused on this terrible template over-riding all else in our lives:

the work place is affected;

the caliber of our work deteriorates as does our relationships with co-workers;

constant preoccupation with this problem precludes normal interfacing with co-workers, family and friends;

even during leisure time there is no relief from this intrusion;

there are no pleasurable or restful interludes with friends or family;

the natural sequelae is seclusion and withdrawal unto ourselves, and yet that very withdrawal serves to compound the depression and frustration of this vicious, self-feeding cycle of despair.

Acute pain that diminishes in the course of the natural healing process is generally manageable psychologically. However, recurrent or persistent pain, which evolves into chronic pain the patient believes is untreatable, and hence threatening to future function and well-being, leads to progressive disability.

Of particular note is the fact that muscles, tendons, ligaments and fascia when so compromised result in pain symptoms (sometimes for decades) whenever tension or stress is a factor during their function.

WHY WOMEN?

Recently, when asked to respond to the question of why more women than men are victims of chronic pain, I suggested the following:

Almost two-thirds of both acute and chronic pain victims treated at my facility are women. This is a common statistic noted at other modern, up-to-speed diagnostic centers located in other states.

Many reasons are given for this phenomena, and any one or more of these may be true. Women are biologically structured differently than men; in addition, oncologists often refer to the variation in women’s emotional profiles.

However, beyond the scientific studies, I am of the opinion that our modern culture places more demands upon our womenfolk, resulting in more inherent stress. It is this increased stress factor that acts as an "enabler" increasing the amount of pain in women’s chronic pain profile.

In today’s society, women are not only the primary focus responsible for the success of the family unit, but in many cases also provide a second income for that family. Thus, besides dealing with issues at the work-place, women are also responsible for the endless list of mundane family chores from laundry to meals to Little League to PTA meetings to, most importantly, supplying the emotional stability pivotal for the whole family unit.

All of the above is expected to be provided by women seamlessly and without complaint. On the other hand, generally women are not usually given the emotional outlets which men often take for granted (i.e., watching sports events with a cold beer in hand, golfing, nights out with the "boys", poker nights, dirt-biking forays, etc.).

Consequently, women are often functioning closer to the edge of their emotional limits. When chronic daily pain enters this equation, they are usually more devastated and certainly more frustrated as they see their many responsibilities challenged and ultimately adversely affected by this all-pervasive entity. Dysfunction is more pronounced and aggravated as the chronic pain persists unresolved and without reason. Worse yet, the woman suffering from chronic pain must bear witness to the debilitating toll this has on not only her whole existence, but on that of all of her family.

This is just a thumbnail sketch of the underlying female psyche as it responds to chronic pain. Add to this equation the responsibilities of single parenting and other such everyday problems and other medical burdens unique to some women and the ensuant consequences are exponentially increased.