The Challenge of Chronic Pain

Pain in the jaw, head, and neck can be difficult to treat.  However the challenge is not necessarily because the pain is so severe, but because it has been present for so long.  This long duration, known as the chronicity of the pain, can thwart many attempts to resolve the patient’s symptoms. 

Acute pain, like a toothache or a wound, has a rather straightforward path to treatment and resolution of symptoms. This is because the cause of the pain is well known, and there are effective methods for dealing with the pain while the problem is treated.

Persons suffering from the same pain on a daily basis for as little as 3 months can be classified as having chronic pain.  What makes chronic pain so challenging is that there are many more factors contributing to the pain.  The following are some examples of what makes chronic pain more challenging:

• Anyone in pain for more than 3 months is at risk for developing emotional and psychological complications, such as anxiety and/or depression.  This can happen regardless of how “emotionally well-balanced” the person was before the onset of the pain.  This psychological overlay causes other problems that make the pain harder to treat.  For example, anxiety or depression disrupts sleep, causing insomnia or preventing the person from sleeping soundly.  Emotional stress creates harmful habits, such as clenching or grinding of the teeth.  Stress also causes increased levels of tension in the muscles, especially those in the upper quarter of the body.  This often leads to a feeling of profound fatigue, in addition to the pain.  Anxiety and depression can also cause headaches and neck pain. Emotional stress often causes abnormal breathing.  Instead of breathing with the diaphragm, the rib and shoulder muscles are recruited--a condition known as "apical breathing."  This leads to symptoms in the neck and jaw.  As these psychological factors bring on other causes of pain, the pain escalates in a vicious cycle.  In addition, chronic pain can impair cognitive function, causing “cloudy thinking.”  This makes it more difficult to function in work or school activities.
• Prolonged pain also changes the way the body perceives pain.  With long-term bombardment of the central nervous system by pain signals coming from the body, the brain becomes hypersensitive, in a condition called central sensitization.  When this occurs, lightly touching the involved area can provoke a severe sharp pain.  This increases the level of suffering of the patient, because they never know when this sudden severe pain will strike. 
• Recent research has shown that, in the chronic pain patient, the brain and central nervous system will actually exacerbate the wound or nerve injury in the body, and create greater inflammation and pain at the site of the perceived pain.  This condition is known as neuropathic pain.   It operates by sending pain chemicals from the brain down through the nerves to the site of the pain in the body.  It is a form of the body attacking itself, such as with auto-immune diseases.
• Sleep deprivation in chronic pain patients prevents the muscles from resting and rehabilitating.  Muscles can only recover when we get adequate deep sleep each night.  In the chronic pain patient, a night of poor sleep will be followed by a day of increased pain.
• Chronic muscle tension, caused by the emotional stress and harmful habits, results in changes within the muscle fibers.  These changes create a new type of pain in the body, known as myofascial pain.  This involves trigger points that develop within the muscles.  Once formed, these trigger points then refer pain to different parts of the body.  A classical example of this is trigger points in the neck muscles that refer pain into the head or jaw.  In myofascial pain, the site of the perceived pain may not be the source of the pain, which may be a problem in a distant muscle.  Myofascial pain is one of the complications in the chronic pain patient.
• Pain medications that work well on acute pain (such as aspirin, Tylenol, or Ibuprofen) are largely ineffective in chronic pain patients.  Even stronger narcotic analgesics, like Lortab or Percodan, are much less effective in chronic pain.  Obviously, this makes the management of chronic pain much more challenging.  For the chronic pain patient, it is more effective to treat the causes of the chronic pain, rather than trying to block the pain with drugs.
• Another area of suffering for the chronic pain patient is the fact that their friends and loved ones do not understand what they are going through, because in many cases the patient looks “normal.”  Too often, they are told to “just buck up”, or to stop dwelling on their pain.  Their doctor may even tell them that they are just depressed.  As a result, they often suffer in silence for years on end.

In summary, to effectively treat the chronic pain patient, it is necessary to address all of the components that are perpetuating the pain.  Failing to recognize and address all of the causes of the pain results in only temporary relief of symptoms.