Sore jaw suf­ferer seeks sleep so­lu­tion

Cape Breton Post - - ADVICE / PROVINCE - Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­corpo- rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at 628

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.

Keith Roach

To Your Good Health

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