Sore jaw sufferer seeks sleep solution
DEAR DR. ROACH: I have been living with TMJ pain on my right side. I believe my situation is unique in that I experience the pain only at night, initially when lying on my right side. While the level of pain is not excruciating, it's more than sufficient to ruin any effort to sleep. Over the years I have tried every over-thecounter pain medication, with no effect. I have been to numerous doctors who specialize in TMJ disorders. I have spent thousands of dollars on bite splints, none of which made any difference. I even tried acupuncture. I have had cortisone injections in the area of the joint and right temple. I have had physical therapy, a TENS treatment and heat treatment, all to no avail. A CT scan of my brain and an MRI of the joint area were unrevealing.
Four years ago, I had surgery on my left shoulder for a torn rotator cuff. For the post-surgery pain, I was prescribed Percocet. I took it only at bedtime and enjoyed the soundest sleep I had experienced in years. I know that Percocet, realistically, is not the answer to my problem due to the potential addiction concern and its decreasing effectiveness the longer it is taken.
My primary care physician is reluctant to even talk about prescribing any narcotic. My dentist seems more open to it, but I am sure there is probably a limit to what she would be able or willing to prescribe. It is a shame that medical professionals seem to be scared to death to prescribe something like Vicodin for fear of causing someone to become an addict, lawsuits, government audits, loss of license, etc. In my case, I am 74 and I am not interested in getting "high." I was embarrassed to even bring up the subject with my doctor and dentist. There seems to be such a stigma attached to narcotics. When I have had the drug available, I take it only at night to allow myself the luxury of a few uninterrupted hours of sleep. It's to the point that I actually dread getting into bed each night knowing what lies ahead. That shouldn't be the case when there is medication available that will greatly help in the elimination or significant reduction of pain. — T.R.
ANSWER: I am sorry to hear about the terrible experience you have had. I hope we can learn two things from your experience.
The first is that sometimes, conditions that medicine should be able to treat defy treatment even by the best experts. I will advise that when someone has gone through as much as you have for TMJ disorder, it sometimes is worthwhile to come at the problem from a completely different perspective. I would be concerned about an atypical presentation of a face pain syn- drome, similar to trigeminal neuralgia, and would consider seeing a neurologist with expertise in facial pain syndromes.
The second issue is about the chronic use of opiates in people with non-cancer pain. There is no doubt that many people are overtreated with opiates, leading to significant side effects and tolerance without adequate pain relief. However, I know there are a few people who do very well with opiates, who do not need to increase the dose over time and who have manageable side effects. Although the trend now is to reduce opiate use, a skilled physician, such as a pain-management specialist, might be comfortable using opiates for someone in your situation.
READERS: The booklet on edema and lymphedema provides information on the causes of foot and ankle swelling. Readers can order a copy by writing: Dr. Roach — No. 106, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
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