Recently, three patient encounters made me think that it may be time to consider formulating a new diagnostic term to categorize countless patients that I see with facial and jaw pain that have no history of disease, identifiable injury, or illness. I am therefore proposing the term PDST or Persistent Domestic Stress Disorder, modeled after PTSD (Post-Traumatic Stress Disorder), which was coined in the 1980’s as a result of ongoing studies of Vietnam veterans who returned from combat as different people.
Though defined in many ways, the most classic definition of PTSD is a “debilitating condition that affects people who have been exposed to a major traumatic event” (Post- Traumatic Stress Disorder, PTSD). Traumatic events that may trigger PTSD include violent personal assaults, natural or unnatural disasters, accidents, or military combat. To fit the criteria of PTSD, the individual must exhibit certain symptoms subsequent to the event(s):
1) intense fear, helplessness, loss of control over daily life events
2) persistent re-experiencing of the traumatic event
3) continual avoidance of reminders associated with the event
4) increased arousal, an overwhelming inability to cope with flashbacks, insomnia, and nightmares
5) a duration of these conditions for at least one month (Spinrad 1)
Surely many of these elements are absent in our pain patients but there are unfortunately many similarities.Though domestic challenges and specific events may not be a vividly upsetting as those encountered in war…they are no less traumatic to the mind and soul.
Consider the following scenarios my patients consistently describe:
* 80-hour work weeks to preserve a job or to become eligible for advancement
* 24/7 care for an elderly parent with progressive dementia
* Persistent worry in young adults focused around achieving in school or finding the right partner
* Verbal or physical abuse at home or in the workplace
* Fragile and unsatisfying marital relationships
* Uninspired children that need ongoing emotional and financial support
* Coping with personal medical infirmities that cast doubt on one’s future
* 24/7 care for an elderly parent with progressive dementia
* Persistent worry in young adults focused around achieving in school or finding the right partner
* Verbal or physical abuse at home or in the workplace
* Fragile and unsatisfying marital relationships
* Uninspired children that need ongoing emotional and financial support
* Coping with personal medical infirmities that cast doubt on one’s future
These are just some of the profiles that are seen routinely in my practice. As a consequence of these challenges, I see increased arousal in my patients’ nervous systems (always in “fight or flight” mode with excess levels of adrenaline and cortisol being found in their bloodstream). I see complaints of insomnia (inability to get to sleep or to stay asleep), shallow breathing patterns (with the end result of imbalances in the levels of oxygen and carbon dioxide in their systems) and acquired behaviors such as tooth clenching, furrowing of the brow, raised shoulders, etc. that fatigue the muscles of the head, neck, face and jaw.
As these challenges persist well beyond one month, the brain remains under siege and ultimately subtle changes in neural thresholds and muscle tone result, leading to pain symptoms along with complaints of ringing/fullness in the ears, burning in the mouth, loss of balance and tingling in the face. Patients come to my office exhibiting helplessness at times and are easily moved to tears when they are reminded of the issues in their lives that they try to avoid thinking about.
Though bringing these concepts to light may make patients wonder if feeling better is even an option when faced with these obstacles, there truly are strategies that I employ that bring definitive relief. I reinforce the concept that the symptoms are real, and that the symptoms are common and familiar to those of us trained in the recognition and treatment of Orofacial pain and Temporomandibular disorders.
The bottom line, however, is that there is no quick fix for something that fortunately is not broken. I stress that fixing the bite, changing jaw positions, or improving posture are not solutions by themselves. Rather I stress that comfort will only be realized if nerve thresholds return to normal, muscle tension eases, sleep is improved and optimism and control are restored within an individual’s personal world.
Treatment in my office often includes strategies to monitor body mechanics and postures, physical self regulation techniques to monitor behaviors prompted by daily tension, diaphragmatic breathing protocol to slow respiration and sleep hygiene education. Referral for supportive care with other health care professionals is not uncommon.
