Listening to Pain: The Key to Healing

In my practice, I treat many patients who suffer from chronic pain. Malocclusion, or a misaligned bite, can stress the facial muscles, compress and malform the TMJ, and cause a great deal of pain in the jaw joints, face, head, ears, and neck. But in all the years I’ve been treating TMJ and chronic pain, I’ve never seen a patient who’s sole source of pain was exclusively from a bad bite or compressed joints. Chronic pain is nearly always multifactorial. There may be a primary underlying cause, but lifestyle habits and stress levels can not only crank up the volume on an existing condition like TMD, but also create a great deal of pain all on their own.

Many patients we work with have travelled a long journey trying to understand the clinical reasons for their pain. They have visited doctor after doctor, receiving different diagnoses, treatments, and medications. Some even undergo surgery in an effort to find some kind of relief, yet still they have pain. Unfortunately, many of these patients we work with are often completely unaware of how their own lifestyle habits and stress levels could be hindering their ability to heal. This is not the patient’s fault. As healthcare practitioners, it is our job to help patients understand not only what we can do to help them, but perhaps more importantly what they can do every day to help themselves.

No doctor can possibly understand what it feels like to be in your body better than you. Pain is your body’s way of telling you something is wrong. With a little time and careful listening, many patients can uncover physical habits and lifestyle choices that create or exacerbate their pain all on their own. Doctors can run tests and take x-rays, but a doctor does not live with you 24-7. Only you know that every time you skip breakfast, you end up with a headache. Or that every time you do a particular weight-bearing exercise, your teeth and jaw ache afterwards. Or that every interaction you have with a co-worker, friend or family member seems to trigger a migraine. Just by paying attention to when your body experiences pain and what is happening in and around that moment, you can gather more information about the possible triggers for your pain than any doctor ever could.

Now, can another person actually cause you physical pain just through conversation? Probably not, but the stress of that conversation may cause you to clench your teeth, tighten your shoulders, and breathe more shallowly. All of those things will definitely give you a doozy of a headache. Medication may help in the short term, but the ultimate cure for that kind of pain is to learn how to interact differently with the people in your life who cause you stress, or to eliminate those relationships altogether if possible. Medication can not do that for you, but practical tools do exist to help you manage relationship stress and decrease its effect on your physical body.

Pain is not a comfortable experience for anyone. It is not meant to be. Your body is trying to get your attention. Listen, look inward, and try to understand its message. You may be surprised at how much information you will receive.

In order to help you do just that, this month I have created a tool that will allow you to see more clearly the many messages your body is trying to send you through your pain. The Daily Headache Diary is a tool for you to use in conjunction with the entire Headache Series. By tracking your diet, medications, and answering a series of questions each day about your habits, you will begin to see if there are any patterns in your daily or weekly routine that regularly coincide with headache pain. That information is incredibly valuable. Even if you do not know what to do with it right away, keep listening, share your new understandings with your treating physicians, and try some of the simple adjustments suggested in the Headache Series to see how much headache pain you can reduce or eliminate all on your own. We are each our own best healers when it comes to chronic pain. Trust your body. It does not lie.

By the way, this is also a helpful tool for other types of pain.

Martha (Signature)

The Benefits of Botox in Dentistry

I have to admit that utilizing Botox, or botulinum A, as a therapeutic treatment for dental and TMD-related conditions was not something I ever anticipated integrating into my practice. Like many of us, my first impressions of Botox came through the huge media attention surrounding the introduction of Botox Cosmetic in 2002. I was hearing a lot about Botox parties for frown lines and wrinkles, but at that time, I had no idea that Botox had been used as a therapeutic medical treatment long before the introduction of Botox Cosmetic.

Botox, as manufactured by Allergan, is now one of three formulations of botulinum A available for medically therapeutic treatment. Botulinum A is a controlled form of the botulinum toxin, a nerve toxin produced by infection with the bacterium clostridium botulinum, commonly known as botulism. One of the most devastating effects of uncontrolled botulism is extreme muscle paralysis. Untreated, this paralysis can become deadly. However, as early as the 1950s, scientists began studying the botulinum toxin as a separate entity from the bacterial infection and discovered that, in small doses, the toxin itself could be used to reduce muscle spasm.

Through the 1960s and 1970s, scientific studies continued to explore the use of botulinum toxin specifically as a treatment for strabismus, or crossed eyes. Finally, in 1989 after nearly 40 years of scientific research, Botox (as introduced by Allergan) was approved by the FDA for the therapeutic treatment of crossed eyes and eyelid spasms.

Today, even though Botox Cosmetic still remains the most visible use of the botulinum toxin, many additional medically therapeutic applications of botulinum A continue to be researched and discovered, including dental applications.

Targeting specific muscles around the lips, botulinum A can significantly improve conditions like gummy smiles, upside-down smiles, lip lines and creases, as well as chronically puckered chins. These treatments are not permanent, but there is growing evidence to support that treatment with botulinum A over time can retrain these muscles into a state of improved relaxation and natural function.

Treating other muscles of the face, head, and neck with botulinum A have also demonstrated measurable relief for headache pain related to chronic and unrelenting tension in these muscle areas. Of course, headaches are almost always caused by multiple triggers and those factors should be concurrently addressed during botulinum A therapy. But for those patients whose muscles simply cannot seem to let go of chronic spasm, treatment with botulinum A can sometimes offer a level of relief that might otherwise not be achievable through other types of therapy.

Certainly, treatment with botulinum A is not appropriate for everyone, and it is not a permanent cure for any of the conditions I’ve mentioned. However, it can be an invaluable tool in improving pain levels and visual appearance while other more permanent treatment solutions are being pursued. If you would like to learn more about each of the specific botulinum treatments that are now available in our office, I invite you to take a look at our newest resource article, Botox in Dentistry. Current or new patients are also always welcome to ask about botulinum treatment at any regular dental appointment, or to call the office to schedule a consultation.

Martha (Signature)

Self-Care for the Holidays

At this time of the year as the holidays come into full swing, it’s easy to forget all the little things we might normally do to take care of ourselves. Our schedules are packed with social gatherings, holiday shopping, and family commitments, leaving many of us tired, stressed out, and quite often more headachy than usual.

Getting lost in all the excitement and activity that always seem to define these final weeks between Thanksgiving and the New Year happens to all of us, so be kind to yourself and don’t waste time with regrets about what you should have done these last few weeks. Take a breath, let whatever is in the past stay there, and start again today with a few simple steps to keep you on the right track for self care in the New Year.

We all tend to indulge a little too much in holiday food, alcohol, and caffeine at this time of year, so if you find that you are having headaches more often than usual – or you aren’t sleeping well – start by taking a look at those areas first. Make sure you are drinking enough water each day. Monitor how many hours you are spending in front of the computer shopping for gifts or making travel arrangements, and make sure you take breaks to stretch your legs, neck and shoulders – and to rest your eyes.

You might also try stretching your jaw a few times a day, especially if you notice yourself clenching or grinding your teeth. Ice or a cold pack on the back of the neck, forehead, or over the eyes can also provide significant relief from many types of tension headaches.

If you have a little more time to spend on yourself, you might also take a moment to review some of our articles in The Headache Series. Each one deals with a specific subset of headache triggers that might very well contain a suggestion or solution to the headache that you may be having right now. This month, we’ve also added a new section to the series covering hormone imbalances, medication interactions, and rebound headaches, as well as several other possible environmental irritants and triggers.

Identifying the source of your tension headache or migraine is always the first step in finding a way to prevent them from occurring in the future. I hope you’ll take a moment for yourself during this busy time of year to check in with your body and start making a few simple changes to your daily routine right now instead of waiting for the New Year to begin.

It’s never too soon to start taking better care of yourself, and what better gift for the holidays could you receive than a pain-free transition into the coming year?

Martha (Signature)

The Stress Headache

Long-term stress is perhaps one of the most damaging states a body can experience. Existing conditions are almost always worsened by the addition of stress, and a healthy person can experience previously unknown levels of pain or discomfort because of stress alone. There are certainly chemical processes in the body triggered by stress that contribute to these effects, but the choices we make when we are stressed are often equally or perhaps even more detrimental to our health than the stress itself.

Chronically stressed individuals tend to self-medicate with food, alcohol, caffeine, drugs, or other stimulants. Physical exercise is often ignored, sleep can be fragmented, and relaxation of any kind can feel impossible when life stressors dominate our thoughts. Add physical pain to the mix in the form of a chronic headache, neck ache, stomachache, or backache, and stress can become truly debilitating.

A young patient of mine at the very end of his senior year in college recently experienced first-hand how stress can create physically debilitating symptoms that can present in frightening and painful ways. Graduation was approaching, finals were looming, and a very large presentation was due before the end of the semester. It was a lot of work to do in a short period of time, but the real stress for this young man did not come from the work itself, but from the worry and anxiety about all the unknowns facing him at the time. Would he be able to finish his presentation? Would he pass his finals? Would he graduate? And the biggest unknowns of them all: What would he do after graduation? Would he be able to get a job? Where would he live? How would he support himself?

He was facing a period of uncertainty for the very first time in his life. And what happened? He got a splitting headache. A headache so painful and unusual for him that even his primary care physician was concerned. The doctor ordered MRI’s and CT scans, prescribed prescription pain medication, and watched him for a couple of weeks. All the scans were normal, but still the headache did not improve.

When he came to me, I listened at length to the obvious amount of stress this young man was not only experiencing from the outside in the form of deadlines and assignments, but also from the pressure he was creating on the inside to figure out his life after graduation. I noticed how tightly he held his shoulders as he spoke and the tension in his jaw. I asked him about his sleeping patterns, his eating, his exercise, how much water he was drinking, and how many cups of coffee and energy drinks he was having each day in order to keep up. The answers created a picture of a complete absence of self-care that so many of us experience at any age when we are faced with extreme stress, uncertainty, and fear.

A short series of neuromuscular massages to ease the tension of the muscles in the head and neck, combined with an effort at better dietary choices and a frank conversation with his parents about the kind of support he could expect after graduation, and the headache went away in less than a week.

Sudden and severe head pain should always be taken seriously, and scans to rule out serious injuries or pathological conditions in the brain are important. But scans and pain medication do not address stress. And even if an injury or pathological state is ultimately causing the headache, stress can turn up the volume of pain associated with almost any condition. This month in our newest addition to The Headache Series, we are exploring how exercise, rest and other self-care habits work together to counteract the effects of stress on our bodies and our brains.

I hope that you will take a look and learn a little bit more about how a few simple stress-reduction techniques and healthy lifestyle choices can reduce or even eliminate the head and body pain most commonly associated with increased stress and anxiety.

Martha (Signature)

the food headache

As a dentist, it’s my job to pay attention to what my patients are eating and how diet might be affecting the health of their teeth and gums. But the way our bodies interact with food is more complicated than that. When we eat and drink food that nourishes us, the body responds by feeling energized and alert. But when we eat food that contains little nutritive value or hinders the healthy function of key systems in some way, the body communicates in the best way it knows how – with discomfort or pain.

Indigestion, heart burn, food poisoning, and other gastric symptoms can all be quite uncomfortable, and it’s easy to relate those reactions directly to food. But the digestive system isn’t the only system in the body that will react when the wrong food or not enough food is present in the system. In many cases, head pain will precede or even replace gastric pain or discomfort as the body’s initial reaction to certain foods.

In my work with TMJ disorders and other forms of chronic pain over the years, I have come to understand that headaches are almost always multifactorial. The position of the teeth and how that relates to joint and muscle function may play a role in triggering head pain, but for most of my patients, other factors are almost always involved. And food, or the lack of it, is often a major contributing factor to the development or escalation of head pain.

We all have different sensitivity thresholds when it comes to imbalances in our bodies. For people who suffer from chronic pain, however, this threshold is often extremely narrow. A slight shift in environmental or dietary conditions can tip the balance for these individuals and trigger a multi-day pain cycle. If you know that you are already extremely sensitive to sound, light, temperature, smell, or other environmental triggers, it would not be unusual to discover that your body may also be sensitive to dietary influences.

This month in The Headache Series, we’re discussing exactly how certain dietary choices can contribute to head pain, and how you can begin the process of identifying your individual sensitivities. Sometimes the answer isn’t in a single food source, but in a combination. Identifying a food trigger does take some effort, and for people with complex dietary triggers or nutritional deficiencies, the help of a good naturopath may be essential to the process. But if eliminating a large portion of your head pain might be as simple as eliminating that afternoon cup of coffee or choosing something more nutritionally balanced than a sugar-laden pastry for breakfast, wouldn’t that be worth looking into?

I hope you’ll take the time to read through The Headache Series: Food Triggers, and explore how a few simple dietary changes could not only make the difference in alleviating a large portion of your head pain, but could also help you feel more energized and alert each and every day.

Martha (Signature)