Chronic Facial Pain; what you can do to manage it

What is the purpose of pain?
Pain may be a warning of damage or injury to our body. When it is prolonged it is forcing us to rest and heal. The severity of the pain however, depends on how our minds "read" this damage. Some pain, like migraines are awful, yet no damage is done to the brain. On the other hand, high blood pressure is destructive, yet it goes on in silence .. no pain is felt. It is our brain/mind which decides whether to alert us about damage to our body. The state of alertness of our brain/mind is a key factor in determining whether we will experience pain or not. When pain becomes chronic there is often very little actual damage occurring, yet our brain/mind is ringing alarm bells inside our head..

Can all pain be controlled?
Operations and drugs get more sophisticated, and hopefully will continue to improve the management of pain by health workers. But there are still many suffering people whose pain cannot be taken away. Pain and suffering seem to be with us for a while ... perhaps a consequence of being alive.

What is chronic facial pain?
Any facial pain which has lasted more than a month can be considered chronic, if all obvious causes of acute pain have been excluded. The pain is usually difficult to localise, and often spreads to the eyes, ears and head. It is usually difficult to open the jaws widely. There is good evidence that tension in the facial muscles can cause chronic facial pain. In most sufferers of chronic facial pain, tender nodules can be felt in the facial and neck muscles which cause the same type of radiating pain when firmly rubbed. These nodules can be reduced by stretch exercises and massage. The dentist or physiotherapist may also use a TENS machine to reduce the muscle tension.
But sometimes there is very little tissue damage occurring in chronic facial pain, in fact it is difficult to find anything wrong at all. The fruitless search for a cause is deeply worrying. As the pain remains out of control, there is a sense of rising panic, that nothing can be done. In desperation for a culprit we may we ask our dentist to replace our amalgam fillings, hoping that the locked in mercury might be a cause. But there is no evidence of any association between amalgam fillings and ill health of any sort including facial pain.
At some point we are likely to be told that it must be psychological. Of course in a way that is true, because all pain has a major psychological component, but it is not true in the sense that the pain is being "imagined". All pain is real to the sufferer as pain is a private and inner experience which no one else can feel or even measure adequately.

Is that it then?
Not at all. When dentists have done all they can there is still a great deal you can still do. In most pain centres of the world, patients are not only treated with surgery and drugs, but they are also learning skills in pain management. These skills help pain sufferers regain control of their lives and restore some quality to their life even though the pain does not go away.

Pain management is a team effort
The most effective way to stop pain is to get to the cause, or at least to exclude infection and cancer, and this requires careful examination by an experienced practitioner. But, at the same time, work must be in progress at another level, that of the brain/mind. All pain affects our feelings and how we think and worry about what our body is doing to us. There is a great deal to be gained by recognising these feelings, searching for their origins, and consciously choosing to alter the way we have been used to thinking. We can become more positive, self-willed and we can regain control of our mind and bodies. But few of us have all these life skills.. They do not come automatically, and we are not taught at school. We need some help in developing them, and this is were the psychologist joins the team. Massage has a supportive role in the management of facial pain, so physiotherapists and complimentary practitioners such as aromatherapists also contribute by restoring a positive outlook and a relaxed body and mind. It also helps to work with other pain sufferers, who want to learn the same skills. So the management of pain is a team effort between the doctors, dentists, psychologists, physical therapists and other patients.

Top

WHAT CAN YOU DO ?
1. Acknowledge your feelings
Pain brings all sorts of feelings, sometimes so deep that we do not know they are there. Search them out, write them down, and share them with someone. Check yourself out on the following; Do you often feel frightened, helpless, exhausted, angry, sorry for yourself, despairing, depressed? Most of us have grown up in a culture which inhibits feelings and we are reluctant to talk about them. Men particularly are reluctant to express their feelings. This is fine in battle, but most men live in peace, and need to be allowed to feel as much as women do. Our lifestyles in peaceful times, are far from peaceful. We are always in a hurry and often stressed, trying to keep up with the demands we make on ourselves. It is not impossible that repressed feelings and inner anguish can actually manifest as physical pain.

2. Keep a record of your pain
Measure how bad it is using a scale of 0 (none) to 10 (unbearable). Write down in a diary how bad the pain is every day. This habit gives you a picture of how things are. It is extremely encouraging to note even the slightest improvement. It also gives us a sense of restoring some control over the pain, a very important shift from being a victim of it.

3. Keep a record of the tablets your take
One of the worst aspects of prolonged pain is feeling helpless, out of control and dependent on drugs. Write down in your diary, how many pain killers you take each day. It is very re-assuring to be able to reduce the amount of drugs you need while keeping the pain under control.

4. Stretch the muscles of your jaw, and neck
Muscle tension is part of a vicious cycle. Even if it is not the cause of your pain, it soon will contribute to it as muscle become tense and painful when we are worried and stressed by pain. Here are some stretch exercises to loosen up you muscles.

For the jaws, put your forefinger on your lower teeth, and cross with the thumb against your upper teeth and prise them apart. This can be painful but stretching tight muscles is.

While you recover from that, tilt your head right down onto your chest, let your breath out slowly, saving just a bit at the end to whisper "Oh well!". Lift your head up and back as far as it will go, and again whisper "Oh well" at the end of your breath. This is the "Yes" exercise.

Now turn your head around sideways, until you can see behind you, again letting out the breath and saying those two important words; and then to the other side. This is called the "No"exercise.

And lastly tilt your head to one side to touch one shoulder, and then the other side. This is the "Maybe" exercise.

Top

GET THESE THINGS BACK INTO YOUR LIFE!
1. Exercise
Taking regular exercise does a lot of good things. It reminds you that you are still in control of your body, and that it still works. It makes you relaxed and pleasantly tired. It allows you to set your own achievable goals for increasing your level of activity. It can be a welcome distraction, particularly if it involves fresh views or different surroundings.
2. Pleasure
Being busy doing the things you enjoy, restores balance to a life dictated by pain. Plan every day, to do some things which give you pleasure. While distracted by having some fun, you will create windows of time in the day , when you can forget the pain for a while.

3. Rest
There is nothing which makes pain worse than fatigue. A good nights sleep makes all the difference to the next day's pain. There are no easy answers to sleepless nights, but a hot bath, warm milk, a back rub, good book, and quiet music before bed, make for a restful if not a sleep filled night. If reading during the middle of the night is too tiring, listen to an audio book which you can borrow from the local library. When all else fails, take rests during the day whenever possible. There is some interesting evidence which suggest that watching TV is less restful than we might think. It is temporarily diverting, but the psychologists tell us that it tends to make us depressed. There are lots of possible reasons for this but whatever they are, consider reducing your exposure to news and events as part of an attempt to still the inner chatter of anxious voices.

4. Peace of mind
You cannot fight pain while you are busy trying to deal with other distressing problems. But it is hard, on your own, to get to those inner voices, let alone put them to rest. Talk to someone who is trained to help you find some peace of mind. It takes courage to recognise that you need some help, but after that, it gets easier and it helps enormously to know that you are not alone.

Top

WHAT ARE THE NON-INVASIVE TYPES OF PHYSICAL TREATMENT?
There is growing evidence to support the use of reversible, non-invasive treatment of most chronic facial pains. Which really means, no operations or dental treatment.
Of the physical treatment which dentists can offer the one with the greatest track record of success is a plastic appliance called a "bite plate " which fits between the teeth. No one is quite sure why it works so well, but it does.
TENS is another relatively simple device, which helps relax taught muscles and relieves some kinds of chronic pain. TENS stands for Transcutaneous Electrical Nerve Stimulation. It runs on a torch battery and is quite harmless unless you have a pacemaker or heart arrhythmia. It can be used at home, is reasonably inexpensive and in some cases is actually more effective than anything else.

The figure shows a TENS machine being held in one hand while the electrodes are held against painful muscles of the face. [TENS machines are available from TensCare on 081 547 1999 or Tens Supplies on 0121 35555 6555.]

A FEW LAST THOUGHTS?
The demon of pain is despair. When we have lost control and hope, we have nothing left. Fighting despair is not a task for the solitary, unless you have extra-ordinary inner resources. Most of us need help to get out of dark inner places... "We have only ourselves, and one another. That may not be much but that's all there is" (Sheldon Kopp). We will always need to restore and nurture the inner spirit, no matter how sophisticated the latest technology in pain relief.

Top

Produced in July 1998 by Moorland Dentistry
www.dentanet.org.uk/moordent