Strategies for coping with disabling pain
Pain, especially if it is recurrent or chronic, can have deleterious effects on a person's ability to carry out daily routines. Although it is not well recognized, pain-related disability is common—and invisible.
Imagine this: A gnawing, dull ache spreads from your jaw to your temples. Movement only causes the muscles to tighten. Stabs of pain begin to occur, sporadically at first, and then more often, until concentration is a lost cause. That test tomorrow morning? All you can think of right now is Tylenol and a mattress. Slamming your textbook closed and opening the pill bottle, you see that you are almost out. This pain is too familiar. This is becoming a real problem.
Pain and the disability associated with it afflicts millions of people around the world. Chronic pain, pain that lasts beyond the usual healing time, costs more than $80 billion annually. In the United States alone, it is estimated that 70 million people have chronic pain and 50 million of them are disabled by pain. Regardless of its etiology, chronic pain can result in physical changes such as disturbed sleep, fatigue, loss of smooth and coordinated movement; cognitive changes such as decreased ability to concentrate, problems with memory; emotional changes such as irritability, anxiety, depression and unresolved stress; and psychosocial changes such as decreased socialization, inability to work and loss of self-esteem. Pain-related disability occurs when pain significantly disrupts the ability to participate in daily activities such as self-care, school, work and leisure activities.
Headaches are the most common pain complaints among Americans. It's estimated that 45 million Americans suffer from headaches. Despite this, headaches and other chronic or recurrent pain conditions such as fibromyalgia, myofascial pain and temporomandibular disorders (TMD), are still not recognized as legitimate health problems. These painful conditions have been labeled orphan health problems, belong to no medical subspecialty, are mistaken for other conditions and illustrate how ongoing pain can become disabling.
Thanks to the advocacy efforts of the Jaw Joints and Allied Musculo-skeletal Disorders Foundation Inc. (www.TMJoints.org) and U.S. Rep. Barney Frank, D-Mass., November has been officially designated Jaw Joints-TMJ Awareness Month in Massachusetts. It's fitting, therefore, that we take a closer look at temporomandibular disorders (TMD). TMD comprises a group of problems relating to the jaw joints and commonly associated with headaches, face and neck pain. According to Dr. Noshir Mehta, director of the Craniofacial Pain Center at Tufts School of Dental Medicine, these disorders are very common, afflicting 18 million Americans, including children, teenagers and adults. The causes of TMD, like many other chronic pain problems, are heavily debated, however factors such as trauma to the head, face or neck, a misaligned bite or intense stress are most often cited as the culprits.
Do you recognize any of the following?
The more times you answered yes to the above, the more likely it is you have a temporomandibular disorder. Early detection and appropriate care resolve most TMD problems. Unfortunately, a significant number of people have chronic pain and dysfunction (e.g., difficulty chewing) related to TMD. Mehta says, for example, if there's a history of joint surgery, multiple treatments without resolution of symptoms and/or multiple caregivers, problems may persist. For students who have a predisposition (e.g. malocclusion), certain behaviors and postural habits may contribute to TMD, such as carrying heavy book bags, sitting for extended periods of time, chronic tensing of muscles, or assuming asymmetrical or awkward postures during study.
The good news is that there is help for TMD. The first and most important step is to get a proper diagnosis from a dentist or doctor knowledgeable about the disorder. Treatment usually includes a combination of a splint worn over the teeth, medications, stress management and exercise. In some cases, referrals for physical or occupational therapy are required. Sometimes repositioning of the teeth with orthodontic care is recommended. Rarely does the condition require surgery.
The following web sites provide more information on how to cope with a pain problem:
Deborah Rochman is a lecturer at the Boston School of Occupational Therapy at Tufts and a clinical instructor at the Craniofacial Pain Center at Tufts School of Dental Medicine.