Healthpharmas. About Health & Medicine

Temporomandibular joint syndrome (or TMJ syndrome to give its most common name) is a condition associated with the jaw muscles which control chewing. The hinge joint between the skull and the lower jaw bone is a common site of pain.

Those with symptoms of TMJ syndrome commonly complain of headache or facial pain. In many cases, they have been labelled as having an”atypical facial pain’ or arthritis of the jaw joint.

Atypical facial pain simply means that the condition is not typical of the recognised physical causes of facial pain such as trigeminal neuralgia or sinusitis. But, with most, there is no evidence of arthritis in the jaw joint.

Rather they commonly and unknowingly clench their jaws and grind their teeth at night. The condition is usually seen as a consequence of day-to-day tension causing extreme muscle tension in the muscles which control chewing.

The TMJ syndrome also commonly causes pain in the ear, the side of the head, and the side of the neck on which the jaw joint is affected. This condition is sometimes confused with the severe pain that occurs in tic douloureux or trigeminal neuralgia.

Other less known effects of the TMJ syndrome include nasal stuffiness, burning of the tongue and mouth and hearing difficulties. These latter can range from clunking and grating sounds in the ears to the relative losses in hearing in the absence of any discernible hearing problem or ear wax buildup.

Many of those seen at the general pain clinic and at the specialised pain clinics at some dental hospitals which deal with mouth and face pain have previously been treated poorly, with unnecessary multiple dental procedures, ear, nose and throat procedures and sometimes neurosurgical operations.

Treatments The simplest form of treatment is the proper application of a dental night splint. This simple plastic device is inserted between the upper and lower jaws and is worn at night, and at times during the day, to prevent grinding of the teeth.

At times, muscle relaxant medications are prescribed and, for those in whom depression is thought to be playing a leading role, antidepressant medication is also prescribed. Among the more com¬monly prescribed medications for this condition are Mersyndol and Norgesic, both of which contain combinations of muscle relaxants and pain killers.

Heat treatment, such as microwave therapy, and relaxation treatment such as hypnosis or biofeedback are sometimes of benefit for this condition.

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Can doctors also play the ‘pain game’? Doctors are at least partly to blame for the public’s rampant use of drugs. Some find it all too easy to reach out for the prescription pad, encouraged by extravagant drug company advertising and ‘free’ samples and by too little time for too many patients, or by too many apparently impossibly difficult problems. Drugs to wake you in the morning. Drugs so you can keep driving when you’re exhausted. Drugs to help you sleep.Drugs to prevent pregnancy. More drugs to cure headaches or a dozen other ‘quick-fixes’. In plain terms, drugs are the easy way out for a doctor faced with a patient who keeps insisting: ‘Doctor, do something!’

The ‘easy’ way out

It may be rare in this era of ‘ Three minute medicine’ to find a doctor who is prepared to take the time to earnestly try to come to grips with a patient’s problems. Patients may also wish to avoid the issue. Or,they may simply not be able to identify the real cause of their chronic pain.

Doctors are bombarded with advertising and scientific journals extolling new drugs and treatments. Patients read about a new miracle treatment and build up the expectation that this is the answer to their problem. On the other hand, rare is the patient who hasn’t been victimised by the ‘It’s all in your head!’ game. The doctor can all too easily dismiss the problem he or she cannot or does not want to solve by simply prescribing tranquillisers. Valium is now the world’s biggest selling drug — despite it being widely recognised as causing emotional depression and even physical dependence when used for overly long periods.

Patients who ‘doctor shop’, picking up several prescriptions along the way, often take a combination of tranquillisers and pain relievers — with devastating results. Even the minor tranquillisers have well-known side-effects and problems associated with withdrawal. When used properly, as muscle relaxants or anxiety-relieving drugs, they still have a major place in medicine in general and the treatment of the patient with chronic pain in particular.

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The frequency, and intensity, of the spontaneous pain attack may increase over the years and the pain may even spread to distant areas of the body. Pain specialists are often surprised how even minor injuries may cause astonishingly severe pain.These prolonged, agonising pains inevitably force us to examine the purpose and the value of pain. First, the pain that occurs before serious injury has real survival value. It produces immediate withdrawal or some other action.

Second, the pain which prevents further injury serves as the basis for learning to avoid potentially harmful objects or situations. Third, pain due to damaged joints, abdominal infections, diseases, or serious injuries, set limits on activity and enforce inactivity and rest. This is often essential for the body’s natural recuperative and disease-fighting mechanisms to ensure recovery and survival.

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You’ll just have to learn to live with it

In many cases pain can be largely modified or reduced substantially. In some, coping skills can markedly help the person experiencing pain to get on with their lives. To simply tell a pain sufferer that they must learn to live with their pain and not support them is unforgiveable.

Make yourself feel better by just looking at someone worse off This implies that some comfort will be taken by the patient in pain by observing another’s misery. This is unlikely to help when your world is totally taken up by your own pain experience.

Medical science can cure anything

Even in the early 1990’s medicine is a long way from having all of the answers. We still have a long to go before we can totally understand and therefore control the pain of reflex sympathetic dystrophy or post-herpetic neuralgia to name but two of the most difficult of the chronic pain conditions to treat.

I won’t have to live with this for the rest of my life

In some circumstances a lifetime of pain is exactly what may have to be coped with. However, many of the management approaches described in this book can go a long way to helping those unfortunate to be in this position to cope.

My pain is my own

To some extent this, is true. However there are now many doctors and their professional colleagues who have taken a special interest in patients with chronic pain. Also much can be learned from fellow pain sufferers.

The doctors don’t give a damn

This a misconception that is simply an incorrect generalisation. As later revealed in this book many doctors simply do not have the skills or the knowledge to help you if you have chronic pain. Hopefully the new explosion of information on chronic pain which has taken place in the last ten years will correct this problem.

All I need is more powerful medicine to get some relief One of the most important principles to be stated in pain management is that analgesics or pain-killers have a very limited role to play in the management of chronic pain and are in themselves the cause of much of the problems seen in pain clinics. One of pain management’s most important shortcomings is the lack of communication of information between pain professionals themselves and with patients experiencing chronic pain. The perceived need for more understandable information about chronic pain, both for patient and professional alike, lead to this book being written.

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Drug abuse (of the so-called ’street’ dings such as heroin, bupenorphine, etc.) can cause headaches in two different ways. Firstly the excess use of the drug can cause headaches directly; secondly, and rather annoyingly, withdrawal from the drug can also cause headaches.

‘The chief problems with drug addiction are in the withdrawal phase, where cramps, shivering, sweating, headaches and a sense of general malaise are added to an intense craving for the drug that has beer* removed. The cause of a headache like this is pretty obvious – and the treatment is not to give yourself more of the drug to which you’re addicted, because prolong the agony. Eventually you will have to go through withdrawal and the longer you’ve taken the drug the worse your symptoms will be. Many of the addictive drugs can cause headaches during the withdrawal phase, but heroin and bupenorphine (Temgesic) are particularly notable examples. Most of the* orthodox medical treatments and Complementary therapies to treat addictions will be helpful.

complementary treatment

Counselling relieves the stress associated with withdrawal symptoms, and this support can relieve headaches triggered by emotional problems and tension.

Herbal remedies which are helpful in withdrawal from drugs (particularly narcotics) are oats, rosemary, balm and skullcap (to calm and lift the depression). Constitutional homoeopathy can help with the withdrawal process, as well as dealing with the symptoms.

Detoxifying and anti-depressant aromatherapy oils, like those suggested for smoking and hangovers, see pages 235 and 236, can have some effect, and analgesic oils, like lavender, bergamot and camomile can be massaged into the temples, skull and neck. Hot baths with any of the suggested oils can be beneficial, and also reduce any associated stress.

Really, any therapy that works for you, that will get you through the difficult withdrawal period, can he undertaken. All of the following therapies offer some treatment, and may be suitable singly, or in combination: acupuncture, acupressure, biofeedback, reflexology, dance, music and art therapies, relaxation therapies, medical herbalism, clinical nutrition, naturopathy, Bach flower remedies, counselling, T’ai chi and kinesiology

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Depression, especially when severe, is potentially life-threatening. Suicides can and do occur- in fact they’re the largest cause of death in the teenage years. Don’t use any of these complementary therapies until you’ve consulted your own doctor and asked his advice. The following approaches are complementary, not alternative; they should he adding to what your doctor is doing, not replacing it.

Almost every single alternative practitioner will vouchsafe his cures, so it is best to proceed with caution and consult a registered and preferably recommended practitioner at all times.

Complementary practitioners generally bold the view that tranquillisers and anti-depressants are counter-productive, for in the long run they don’t cure the cause of anxiety, but simply mask its symptoms. Instead they may suggest herbs, for instance, that claim to treat the anxiety itself; these include balm, camomile, hops, motherwort, orange blossom, skullcap and vervain. The headaches of anxiety and depression are best treated by balm, camomile, Jamaican dogwood, lavender and white willow (aspirin in its natural form).

Clinical nutrition offers a Pandora’s box of possibilities. Licorice is thought to have anti-depressant properties; magnesium is said to play a useful role in the treatment of depression, for it is known to be involved in the synthesis of some of the brain’s neuro-transmilters. Vitamin B12 is the legendary doctor feelgood vitamin (used so excessively in the Sixties and Seventies). Vitamin B6 is also said to help in the treatment of depression/anxiety. In general, a consultation with a registered clinical nutritionist will ensure that no subclinical deficiencies are responsible for your anxiety or depression – which often can be biologically triggered.

Everyone’s depression is different, and an aromatherapist would select oils suitable for your changing needs. Some suggestions might be camomile, clary sage, lavender, sandalwood and ylang-ylang- which have both sedative and anti-depressant qualities and so may be helpful if you are suffering from early waking or acute anxiety. Bergamot, geranium, melissa and rose are uplifting and anti-depressant; neroli and jasmine are beneficial when suffering from some of the more debilitating effects of anxiety/depression, such as extreme inexplicable fatigue, headaches, emotional instability, digestive troubles and broken sleep. Massage is important because of the physical contact and baths and vapourisation are equally effective. Baths are often a cleansing experience, and it can be a psychological boost to have one at the end of each day, to effectively wash away that day’s troubles.

Osmotherapy, which is another form of scent therapy, based on slightly different principles to aromatherapy, has been used successfully in the treatment of anxiety/depression – even acknowledged and practised by some British hospitals. Certain scents may he as powerful as tranquillisers. In a hospital in Worcestershire in the UK, certain fragrances were used to reduce anxiety in patients, and a close correlation between the action of fragrance molecules and that of mood-altering drugs (like anti-depressants or tranquillisers) was discovered. A trained and recognised osmotherapisl will he able to treat your individual symptoms. This is particularly helpful for those patients who have been addicted to tranquillisers at any time.

Bach /lower remedies may be helpful in treating anxiety/depression, since they are claimed to affect the negative emotions, replacing them with a sense of calm. Try aspen for apprehension and foreboding, rock rose for extreme panic or terror, larch for despondency. Rescue remedy is a common standby for extreme anxiety or fear.

Acupuncture may also help with anxiety and depression.

Other complementary therapies include: acupressure, reflexology, counselling, the Alexander technique, T’ai chi, Transactional Analysis (TA), kinesiology and the relaxation therapies such as biofeedback,.

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Work is one of the biggest causes of stress in our lives. We can be stressed by the work itself: we worry whether we are capable of doing it properly, or whether we can get it completed on time, and what the boss or our peers think of our performance. Then there’s the responsibility of being in charge of people, and the particular stresses of middle management – caught in the nutcracker between the demands of top management on the one hand, and the shop-floor on the other,

In today’s world there’s the increased threat of redundancy, or the related feeling that the continuation of you job is in the hands of people outside your industry – such as the banks – who may put you out of business.

Stress is a potent cause of headaches. Coping with stress is a large subject, and beyond the scope of this book. However, there are many very good book on alleviating stress available in all bookshops.

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Behavioural Problems

Tension headaches can occur in children just as in adults and this is the second most common cause of headaches, after the headaches of infections. The underlying causes can include fear of school, especially where there is bullying, or the child doesn’t get on well with his teachers; it can be a reflection of family disharmony – parental break-up, relationship problems with brothers or sisters, difficulties with adjusting to a new baby in the family, the illness or death of a parent, or sexual abuse. Don’t forget the effects of TV and videos – often younger children arc exposed to material that is very frightening.

Tension headaches in children are a sign of unhappiness and stress. Gently talking through the child’s worries may quickly point to what is wrong, but professional help may also be needed. It’s important to remember that the tiniest changes in routine can all cause stress on a child. And stress, as we know, is the precursor to tension headaches.

Epilepsy

Epilepsy isn’t just a childhood disease, but most cases do start at this time. Epilepsy can cause headaches in the period immediately after a fit.

The most important thing you can do when your child is suffering from any illness is: don’t panic. Even if they do occur more commonly in childhood, they are still rare. Deal with your child calmly and methodically. Assess his or her symptoms and if you are worried or in doubt call your doctor.

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No, it’s not a music-hall joke – headaches and intercourse do have a direct connection, rather than the proverbial inverse relationship! Of course, having a headache may prevent you from enjoying intercourse, and its a good excuse for avoiding it, but headaches can occasionally relate to the act of intercourse itself. In complete contradiction to the joke, headaches with intercourse are more common in men!

There are three types of headache that can occur at intercourse. The first is an exacerbation of tension headache, and in patients who get tension headaches, intercourse may bring on a dull ache over the whole head. It may be more severe than tension headaches previously experienced, and it is probably due (amongst other reasons) to over-dilation of arteries in the head.

The second type of headache is caused by a ruptured artery adjacent to the brain: a sub-arachnoid haemorrhage. Blood pressure rises during intercourse and this may be the final straw which causes an already weakened artery to rupture. (About one in forty cases of sub-arachnoid haemorrhage occur during intercourse.

The third type of headache, benign orgasmic cephalgia (which is a bit of a mouthful, so I’ll call it ‘true coital headache’), is actually quite rare. It’s a sudden, explosive, one-sided headache coming on at intercourse, and lasting for a few minutes up to a few hours. Not only is it rare, it doesn’t affect the patient every time he makes love. Some patients experience a period of several months during which they get this type of headache during love-making, but then the tendency dies away and they are no longer troubled. In other patients, the headache occurs only occasionally, but on a seemingly random basis.

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