This is quite a common question I get from my clients when they are in the middle of an all-too-familiar TMJ flare-up.
I could be smug and answer it by saying “Whether you think you will or think you won’t you are right.” Normally a client may respond with this “You asshole! I am going to shank you with a dull letter opener while you are sleeping!” Even with the threat of severe maiming, it does not change most of the truth in the statement. There lies the secret of chronic pain in general and chronic TMJ disorders.
The problem with severe TMJ symptoms is the huge emotional response that occurs when someone has tinnitus, dizziness, severe headaches, and jaw pain all right next to our central nervous system. It activates our limbic system because it is so upsetting to our daily life, everything we do involves our jaw. When a severe flare-up occurs, we begin a cascade of rapid shallow breathing, tense muscles, increasing blood pressure, and of course pain. Memory is enormously powerful because of the strong emotional response, and once it occurs one time, we cannot help but believe that the next flare-up is going to be worse than or equal to the worst flare-up we've ever had. We begin to believe that we will always be this way and never get any better.
We never understood the emotional aspect of pain until very recently and it took a horrifying opioid crisis to force modern medicine to look at things in a unique way. We now know with chronic pain we have a centralized pain that is coming from a brain that has been rewired. The pain alarm in a “non-chronic pain brain” is meant to keep us from permanently damaging tissue or dying, but the chronicity of the pain (over 3 months) has caused our brain to confuse pain for a severe fight or flight response. Our brain begins to believe that all pain coming from our jaw means maiming or death!
The brain has a pain alarm and everybody has a different baseline before the alarm goes off. For instance, a steelworker working over a blast furnace burning himself has an exceedingly high threshold for small burns. His body experiences small burns constantly so the brain has learned to ignore it otherwise he would never be able to function in his job. However, if you took an office worker and started spitting sparks of hot steel from his computer screen at random times he would howl in pain!
Read the above paragraph again. The key is understanding this concept.
Your diagnosis does not determine your function or dysfunction. When your jaw pops or you have a twinge of pain your body is going into a fight or flight response. You need to head it off at the pass by deep nasal breathing, telling yourself the pain will quickly subside, and doing your exercises calmly to control the symptoms. You may even try to occupy your brain with something you really enjoy. Eventually, if you repeat this, your brain will begin to realize that the pain is just like the spark hitting the steelworker's arm.
Here is a neat thing. If we took Harry the office worker and told him “Hey Harry, occasionally, when you open a ZOOM meeting, hot sparks are gonna fly all over your desk.” He would be prepared after it happened to him a bunch of times so the small burns would not alarm him as much. He would now know that this is just part of what can happen, and it cannot be any worse than a boring videoconference with Jeff from accounting. He will put on protective gear for ZOOM meetings and he would yelp for a second and then report the daily TPS report as if nothing happened.
I understand what I just wrote is hard for people to hear. I have treated a ton of people with TMJ, and the average time since the onset of pain in my patients is 3yrs. Many of my patients have a 10-30 year history. I know what I said seems daunting, and you may not like me right now for saying it, however, you need to hear it! TMJ disorders suck. I am not minimizing what you all are going through.
In many ways, TMD is not unlike many chronic musculoskeletal disorders. They all have flare-ups and times that are better. However, almost all cases improve with physical therapy-based self-treatment. It does not mean the condition goes away in every case. Many of you are still working in a steel factory. It means our symptoms resolve or severely improve because we no longer have a response to the sparks.
We developed TreatmyTMJ for exactly that. Our program teaches you how to improve everything you can for posture and range of motion and positioning of the jaw so that the body can heal optimally. And we also give you the tools to deal with the flare-ups. When you understand what to do to control your symptoms and how to self-treat with exercises and self-mobilization techniques you can teach your brain it's just sparks coming out of a computer screen. It takes time, patience, and some yelps, but it will happen.
Spend time doing what you love with people that make you feel good.
Dr. Josh
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