Knowledge is key to making empowered decisions about your health. We’re dedicated to making your health a priority by keeping you informed on how to achieve your optimal well-being. In part one of this month’s newsletter, we touched on the hot topic of chronic pain. In part two, we take a deeper dive into how we approach managing and healing chronic pain in our office.
Chronic Pain Recap:
In the United States, chronic pain affects over 100 million people, surpassing the combined number of those with diabetes, heart disease, cancer, and stroke. Chronic pain conditions are notoriously difficult to treat, as it often leads to changes in the nervous system that heighten pain sensitivity, complicate efforts to find relief, and make it challenging to find the root cause. The pain can stem from physical factors such as injuries or conditions like temporomandibular disorders (TMD), and sleep-related breathing disorders. Chronic pain is also influenced by psychological stressors, lifestyle choices, and environmental factors, all contributing to a cycle of pain and discomfort.
Conventional healthcare approaches often focus on symptom management rather than addressing the root cause, leaving many individuals without answers and trapped in a cycle of ongoing pain. Our office employs advanced diagnostics and personalized treatment plans to identify and treat the root cause(s) of chronic pain and sleep issues, recognizing the intricate connection between the two. Effective management of chronic pain in this practice involves a multifaceted approach that considers the individual's entire well-being—mind, body, and spirit—aiming to break the cycle of pain and improve quality of life.
To read more about chronic pain and how we evaluate chronic pain presentations in our office, take a look at part 1 of the chronic pain edition of our TMJ Wellness Newsletter: Understanding Chronic Pain: A Complex and Personal Experience.
Chronic Pain Services in Our Practice
At the TMJ & Sleep Therapy Centre of Cleveland, we specialize in treating chronic pain conditions including craniofacial pain [pain in the head, face, jaw, and neck] and sleep-related breathing disorders [snoring, adult & pediatric OSA, UARS].
In part 1 of the chronic pain edition of our newsletter, we listed the various treatment modalities offered in our practice to help chronic pain sufferers manage and heal from their pain. Let’s take a deeper dive into each of these treatment options:
Oral Appliance Therapy
Oral appliance therapy (OAT) is a non-invasive treatment option that is highly effective in treating chronic pain, particularly craniofacial pain conditions such as migraines, and temporomandibular joint (TMJ) disorders. OAT is also a great option for treating sleep-related breathing issues such as snoring, Upper Airway Resistance Syndrome (UARS), and Obstructive Sleep Apnea (OSA), which we know to be linked to chronic pain conditions. The custom-fitted oral appliances work by decompressing the jaw to take pressure off the joints, reduce contraction of the surrounding musculature, reduce inflammation in the joints and muscles, improve airway function during sleep and enhance sleep quality. Overall, oral appliance therapy provides a targeted approach to addressing the underlying mechanical and structural factors that contribute to chronic pain, offering patients a pathway to relief and better overall health.
Functional Breathing
Functional breathing practices go deeper beyond just inhaling and exhaling. Simply put, functional breathing involves maintaining nasal breathing, as opposed to mouth breathing, both in the daytime and the nighttime. It is a necessary component to treating chronic pain conditions and sleep issues in our office.
Mouth breathing alters the posture of the tongue, jaw, and head, adding extra weight to the neck and upper back, whereas nasal breathing reduces forward head posturing and significantly lessens the stress on the neck that contributes to neck pain, back pain, jaw pain, headaches and more.
Functional breathing practices are essential for improving sleep quality and treating sleep breathing disorders, such as sleep apnea. Nasal breathing ensures proper filtration, humidification, and oxygen delivery to the lungs, which promotes deeper, more restorative sleep. It also reduces the likelihood of airway obstruction, a common issue in sleep breathing disorders. In cases where bruxism (teeth grinding or clenching) is occurring, nasal breathing becomes even more critical. Mouth breathing can cause or exacerbate existing TMJ dysfunction by causing repetitive microtrauma to the jaw joints and surrounding muscles. By encouraging nasal breathing, especially during sleep, individuals can mitigate both breathing-related sleep disturbances and craniofacial pain, leading to improved overall sleep quality and pain relief.
Functional breathing techniques can also be effective in managing chronic pain by reducing stress and enhancing relaxation. These techniques encourage proper oxygen exchange and can activate the parasympathetic nervous system, promoting a state of calm that can help lower pain perception. Controlled, deep nasal breathing exercises can also decrease muscle tension and reduce inflammatory responses, both of which are often elevated in chronic pain conditions. Additionally, mindful breathing can help improve emotional regulation, which is crucial for those experiencing pain-related anxiety or depression.
Sleep Hygiene Practices
Sleep hygiene practices are critical for managing chronic pain yet often under utilized in treatment. We teach key foundations for good sleep hygiene in our practice which include maintaining a consistent sleep schedule, creating a relaxing bedtime routine, minimizing blue light exposure, and optimizing the sleep environment—keeping it dark, quiet, and cool. Limiting stimulants such as caffeine and alcohol, and avoiding inflammatory foods, especially before bedtime, will improve sleep quality. As well, cognitive-behavioral techniques, such as relaxation exercises and mindfulness, can reduce anxiety related to sleep and pain, aiding in the management of symptoms and making it easier to fall asleep.
Laser Therapy
Laser therapy is a very valuable tool in our office for managing and healing from chronic pain and inflammation. We often utilize MLS laser therapy, which uses synchronized wavelengths of light to penetrate tissue to reduce inflammation and oxidative stress, while also stimulat blood flow, all of which aid in alleviation of pain. This therapy also promotes cellular regeneration and accelerates the the body's healing processes without significant side effects like many pain medications, making it especially effective for chronic pain conditions involving musculoskeletal pain.
We also provide DEKA Nd:YAG laser therapy, which utilizes a neodymium-doped yttrium aluminum garnet crystal as a laser medium. This laser is known for its deep tissue penetration, and ability to promote cellular repair, reduce inflammation and alleviate pain. This laser can also help to increase blood flow, reduce muscle tension and enhance tissue and nerve healing, making it a powerful tool in our office for treating chronic pain conditions like musculoskeletal pain and even neuropathic pain.
Prolotherapy and Platelet-Rich Fibrin (PRF) Injections
For chronic pain conditions, prolotherapy and PRF injections can help repair damaged tendons and ligaments, and stabilize joints, effectively resolving the biomechanical issues contributing to pain.
Prolotherapy is a regenerative treatment that involves injecting an irritant solution, typically containing dextrose, into ligaments, tendons, or joints to stimulate the body's healing response and repair damaged tissue. This low-risk treatment option offers a natural, non-invasive alternative for chronic pain relief by encouraging the regeneration of connective tissues rather than merely masking pain symptoms with therapies like Botox.
Platelet-Rich Fibrin (PRF) injections are also a regenerative therapy that uses a concentration of the individual’s own platelets and fibrin from their blood to promote healing and tissue repair. PRF is a step up from prolotherapy because it contains growth factors and cytokines that accelerate healing at a cellular level, offering more potent regenerative effects.
Nutrition and Functional Medicine
We offer nutrition counseling and functional lab testing in our office to provide an individualized nutrition and supplementation protocol to go with each individual’s treatment plain.
Nutrition is a crucial component in treating chronic pain, as a whole food, plant-centric approach can effectively reduce systemic inflammation, lower oxidative stress, improve metabolic health, enhance tissue repair, and more. Prioritizing vegetables, fruits, high quality protein, and healthy fats while limiting ultra-processed foods and addressing food sensitivities will help lower pain sensitization and improve overall health.
Specifically, for individuals with craniofacial pain disorders or sleep-breathing disorders, nutrition therapy is especially important to ensure optimal nutrient intake despite chewing discomfort, manage bruxism, enhance nasal breathing and improve overall sleep quality, all of which support pain management and recovery.
Supplementation and Medications
We utilize targeted supplementation as part of a natural regimen to reduce pain and inflammation, offering fewer side effects than prescription medications. Supplements such as turmeric (curcumin), grape seed extract (GSE), omega-3 fatty acids, magnesium, B-vitamins, and vitamin D are amongst the most commonly utilized in our practice because they are known for their anti-inflammatory and pain-relieving properties.
Turmeric (curcumin), GSE, and omega-3’s for example, have been shown to inhibit inflammatory pathways; omega-3s are also essential for cellular health and tissue repair. Magnesium has an effect on reducing central sensitization, or our pain sensitivity response, while also playing a role in muscle relaxation, making it effective for pain and sleep issues. Vitamin D and B vitamins contribute to immune function and nerve health. Additionally, vitamin D has been shown to play an important role in sleep regulation as well as calcium absorption, making it important for optimal bone health. These supplements, when used in conjunction with dietary and lifestyle modifications, provide a supportive environment for long-term healing from pain.
There are absolutely times when prescription medications are necessary to reduce inflammation as quickly as possible for relief from pain, particularly in acute situations or when other interventions have yet to take full effect. However, medications are not often our primary approach for chronic pain management. They are used situationally and in combination with root cause protocols that address underlying causes of inflammation, joint instability, and tissue damage etc. By integrating medications with lifestyle changes, supplementation, nutrition therapy, and other root cause treatments, we aim to relieve pain without relying solely on prescription drugs in the long-term, reducing the risk of side effects and other consequences of prolonged medication use.
Functional Lab Testing
Functional lab testing offers a deeper insight into what the underlying cause may be to an individual’s chronic pain by using narrower or “optimal” reference ranges and a more individualized approach than conventional lab tests. While conventional labs identify health conditions once they fall outside broad "normal" ranges, functional testing seeks to detect imbalances even before they become clinically significant. This allows for earlier interventions, especially in chronic pain conditions, by identifying underlying inflammation, oxidative stress, nutrient deficiencies, or gut and hormone imbalances that may be contributing.
Gut Health
Gut health is intricately linked to chronic pain, as imbalances in the gut microbiome can contribute to systemic inflammation, exacerbating pain conditions. In addition, gut dysbiosis and inflammation have been connected to impeded nasal breathing and bruxism, as well as sleep disturbances, all known to worsen pain related conditions and sleep breathing issues.
Testing options such as a comprehensive stool analysis or intestinal permeability tests can identify imbalances in gut bacteria, leaky gut (intestinal permeability), and food intolerances, all of which can affect inflammation and pain. Addressing gut health through targeted treatments can reduce bruxism.
Hormone Health
Hormone imbalances, particularly involving cortisol, estrogen, progesterone, and melatonin, can contribute to chronic pain, bruxism, and sleep disturbances. Elevated stress hormones, like cortisol, can worsen pain sensitivity and disrupt sleep, while low melatonin levels can affect the body's ability to regulate pain and sleep cycles.
Hormone testing, such as saliva or urine panels, can provide a comprehensive look at circadian rhythms and hormone levels, allowing for more personalized interventions to balance these hormones and improve associated symptoms.
Acupuncture
Acupuncture is a well-established ancient Chinese-based technique that is particularly effective for treating a wide variety of health conditions by triggering different points on the skin with small, one time use, disposable stainless steel needles. It is based on the idea that a blockage, or disturbance in the body’s flow of qi (energy flow) can cause health issues.
Our acupuncturist, Dr. Dickerson, practices auricular acupuncture, which is considered more modern Chinese acupuncture, by comparison to traditional acupuncture. Auricular acupuncture specifically targets the ear, where various points in the ear correspond to different organs and systems of the body. The ear is closer to the nervous system (brain), allowing for faster and longer lasting results with this form of acupuncture.
This therapy is particularly effective in treating chronic pain conditions, such as migraines, musculoskeletal pain, and neuropathic pain. By stimulating these auricular points, acupuncture can modulate the nervous system, reduce inflammation, and promote the release of endorphins, the body's natural painkillers. Additionally, auricular acupuncture has been shown to improve sleep by balancing the body's qi and reducing stress and anxiety, which are common contributors to sleep disturbances. This dual action on both pain relief and sleep enhancement makes auricular acupuncture a valuable tool in our office.
How We Can Help:
If you suffer from chronic pain and/or sleep issues, reach out to our office to schedule a comprehensive evaluation to bring you one step closer to healing from your chronic pain and getting more consistent, restful sleep.
What’s Next?
Next month, we are eager to take a deeper dive into the sleep portion of our practice. If you are interested in learning more about how you or a loved one can get a better night’s sleep, make sure you subscribe to our TMJ Wellness Newsletter!
Additional Resources:
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- Mayer, E. A., et al. (2021). "Gut-Microbiome-Brain Axis: The Impact of Gut Health on Pain and Neurological Function."
- Talbot, J., et al. (2020). "Hormonal Influences on Chronic Pain and Sleep Disorders."