Understanding Chronic Pain: A Complex and Personal Experience

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Exploring the Nuances of Chronic Pain: Why Every Journey is Unique

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 this month’s newsletter, we touch on the hot topic of chronic pain.

Is persistent pain a constant companion for you or a loved one? You are not alone!

In the United States, over 100 million people live with chronic pain, surpassing the number of individuals affected by diabetes, heart disease, cancer, and stroke combined.

Many who suffer from chronic pain feel stuck…chasing ways to manage their symptoms and feeling lost as to why they cannot seem to find long-term relief.

Discover the potential root cause(s) of chronic pain and the intricate relationship between craniofacial pain conditions and sleep-related breathing disorders.

What is Chronic Pain?

Chronic pain is not the same as acute (temporary) pain, which you might feel from an injury, surgery, or illness. Acute pain serves as one of the body’s protective mechanisms, indicating that something is wrong and prompting the immune system to turn on. Acute pain is generally short-lived, lasting from a few seconds to a few months, and it usually subsides once the underlying injury or illness has been treated or has healed.

On the other hand, chronic pain is the type of pain that sticks around, and is present for more than three months, even after the initial injury or condition has been resolved. Chronic pain causes changes to our nervous system. These changes can cause the brain to continue to send out pain signals throughout the body, even where there may be no harm or damage. The signal pathway to the brain can then become oversensitive and amplify our pain sensitivity.

Chronic pain is not always easy to understand due to its varied presentations and bio-individual nature, making it sometimes hard to determine the root cause(s). Common underlying causes to chronic pain include physical causes, lifestyle & environmental factors, and psychological & emotional causes.

Physical causation can be due to a past injury (i.e. fracture, surgery, sprain), or a disease in itself, such as in cases of musculoskeletal pain (i.e low back pain) or migraines/headaches, or it can be linked with other chronic conditions such as:

Temporomandibular disorders (TMD/TMJ)
Sleep breathing disorders (i.e. OSA, UARS)
Arthritis (Osteoarthritis and Rheumatoid)
Obesity
Fibromyalgia
Neuropathy (diabetic or chemotherapy-induced)
Irritable bowel syndrome (IBS)
Chronic fatigue syndrome (CFS)
Endometriosis
Lyme disease
Autoimmune conditions

The common underlying thread for most physical causes of chronic pain is inflammation. This is why one of our initial tenets of care is utilizing a multitude of therapies to reduce inflammation as quickly as possible.

Psychological and emotional contributors to chronic pain may include mental health disorders and unresolved emotional or psychological trauma. The research also tells us that there is a bidirectional relationship between these psychological stressors (like anxiety and depression) and pain, meaning that chronic pain can cause these mental health conditions.

Lifestyle and environmental factors that may contribute to pain severity include poor diet, lack of exercise, body composition and poor posture (which can also be related to structural abnormalities or breathing dysfunction).

This increasingly prevalent public health issue significantly impacts individuals quality of life, leading to emotional and physical challenges that may require long-term management and treatment strategies.

Our conventional healthcare model often prioritizes treating the symptoms of chronic pain rather than finding out the root cause, and this approach is failing so many of us.

Chronic Pain 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].

Temporomandibular disorders (TMD/TMJ) have been identified as a leading cause of chronic craniofacial pain. Untreated issues in the jaw can lead to involuntary postural changes in effort to alleviate jaw discomfort. These changes in our head and neck posture can lead to chronic pain in other areas of the body such as the shoulders, trap muscles, lower back, and even in the lower extremities such as the knees and feet.

The #1 reason individuals come through our doors is due to their persistent pain complaints. In addition to helping these individuals get out of pain, our main goal is to figure out what is causing their pain in the first place.

A comprehensive evaluation that includes a deep dive into their health history, lifestyle and a full physical exam is necessary to identify all contributing factors to chronic pain. As part of our physical examination, we utilize cone beam computed tomography (CBCT imaging) to evaluate bony structures from the neck up to the top of the head and assess the upper airway, which includes the sinus, nasal cavities, and pharynx (throat). We also perform motor nerve reflex testing (MNRT), which is a method of evaluating the nervous system to identify the source of the pain. Oftentimes, where the pain is being felt is not in the same location as the underlying injury. Our goal is not only to treat the pain symptoms, but also identify and heal the underlying injury, which is necessary to truly heal from the chronic pain.

During our evaluations, assessing sleep quality and breathing is never neglected. This often leads to us being asked why we treat both pain and sleep in our office. The answer to that is simple (sort of) …

Research indicates a significant overlap between chronic pain and sleep issues.

According to various studies, 50% to 80% of individuals with chronic pain also experience sleep disturbances such as insomnia, sleep apnea, UARS and restless legs syndrome.

Not only is this relationship indicated in the research, but also apparent in our daily practice. Of those individuals that see us for pain, we find about 90% of them have comorbid sleep issues.

This high prevalence highlights the intertwined nature of sleep and chronic pain, where one condition often exacerbates the other, creating a cycle that can be challenging to break but cannot be neglected in treatment.

The Relationship Between Pain and Sleep

Evaluations on sleep and pain support a reciprocal relationship between sleep disturbances and pain complaints. This means that pain and sleep can mutually influence one another: each can be the cause and the effect. In other words, pain can lead to poor sleep quality and sleep issues can lead to more pain.

Chronic pain can significantly impacts sleep in several ways:

Difficulty Falling Asleep: Pain can increase the time it takes to transition from wakefulness to sleep, known as sleep latency, making it harder to get a full night’s rest. This can be due to discomfort and pain making it hard to relax and find a comfortable sleep position. The anticipation of pain can also create anxiety, further hindering sleep onset.
Nighttime Awakenings: Pain can cause more frequent awakenings during the night, leading to fragmented sleep. This can prevent individuals from reaching and staying in the deeper, restorative stages of sleep.
Reduced Sleep Quality: Even if individuals with chronic pain manage to sleep through the night, the quality of their sleep is often poor. They may not experience enough deep sleep or REM sleep, which are crucial for physical and mental restoration.
Daytime Fatigue: Poor sleep quality and quantity due to chronic pain can lead to daytime fatigue, making it difficult to function effectively during the day. This can create a cycle where fatigue exacerbates pain, and pain continues to disrupt sleep.

Poor sleep and sleep breathing issues impact on chronic pain:

Sleep breathing issues: Untreated obstructive or restrictive breathing at night time or mouth breathing at night disrupts sleep by causing frequent awakenings and fragmented sleep, preventing the achievement of deep, restorative sleep stages. This can result in poor sleep quality, daytime fatigue, and decreased overall well-being.
Central Sensitization: Repeated sleep interruptions can cause changes in the central nervous system, leading to heightened sensitivity to pain.
Inflammatory Response: Systemic inflammation in the body can lead to sleep disturbances and sleep disturbances also drive systemic inflammation. This cycle lowers the pain threshold and is a common underlying factor in many chronic pain conditions.
Impaired Healing: Poor sleep can hinder the body’s ability to heal and recover from injuries and illness , leading to prolonged or unresolved pain.
Neck hyperextension: Any obstructive or restrictive breathing at night time or mouth breathing can lead to involuntary hyperextension of the neck in effort to keep the airway patent. This can lead to impingement of the nerves in the neck.
Sleep Bruxism (teeth grinding/clenching): Obstructive or restrictive breathing at night time or mouth breathing is a major contributing factor to grinding/clenching of the teeth in an attempt to reopen the airway, leading to craniofacial pain such as headaches, jaw/facial pain, tooth sensitivity, etc.. It can also lead to exacerbated neck pain in the morning, which may lead to forward head posture and prolonged neck pain throughout the day.
Stress and Mood Disorders: Chronic sleep issues can lead to stress, anxiety, and depression, which are known to exacerbate and maintain chronic pain conditions.

Addressing sleep issues in individuals with chronic pain often requires a multifaceted approach, but is crucial for effective treatment and improved quality of life.

How We Address Chronic Pain In Our Office

In our office, we choose to blend conventional and integrative wisdom to create individualized plans to manage and treat chronic pain from the root cause. Some of these treatment modalities include:

Oral Appliance Therapy
Functional Breathing Re-education
Sleep hygiene practices
Laser Therapy
Prolotherapy/PRF
Nutrition
Supplementation / Medications
Gut Health
Hormone Health
Functional Lab testing
Acupuncture

Additional considerations may include the addition of physical therapy, chiropractic care, myofunctional therapy, massage therapy, talk therapy, and/or ENT consultations into treatment.

Our methodologies align with integrative and functional medicine principles of treating patients as a whole and taking into account all aspects of their lives–mind, body, and spirit–in healing the root cause of pain.

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?

Stay tuned for part 2 of this month’s chronic pain newsletter, where we dive in and discuss the various therapies that we utilize in our office to treat chronic pain. Part 2 will reach your inbox on August 23rd!