Since most TMD cases are chronic in nature (with recurring acute symptoms), those of us treating TMD have a large number of chronic pain patients.
The TMD doctor must recognize whether a particular patient is suffering from Chronic Pain and address the Chronic Pain issue first before initiating treatment for the TMD problem or treatment is doomed to failure.
Chronic pain is too often unnecessary, but due to lack of understanding, and inadequate treatment premises, is often found in TMD patients.
Chronic pain victims have in all probability been over medicated; in addition, many of their current medications are counter-productive to each other. This is NOT the time for more medications! Mis-use and over-use of medications has already obfuscated the original soft tissue injuries and dysfunctions making it more difficult to determine the root cause or etiology.
This IS the time for essential diagnostics so that an effective treatment plan may be developed. Chronic pain victims can, do, and will, tolerate a modicum of daily pain and still function; any reduction in the daily level of pain leads to some vestige of hope, thus initiating their road back to normalcy.
The Chronic Pain Persona
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 often 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 disease, 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 do 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.
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.