Wikipedia redux: from tmj, trigeminal neuralgia to dog diseases, cherbuism and a list of Star Trek races

Disclaimer: The first part of Day 11’s prompt is meant as satire, and not to belittle chronic pain, nor the WEGO #HAWMC’s April project. I was feeling a bit tongue in cheek. I did get more serious for the second part.  And, WordPress messed up my fonts again!

The task for todays #HAWMC was to “revise your condition’s Wikipedia” page. . .  . Has Wikipedia forgotten to include your condition.” So, I wikied atypical facial pain, choosing it over health issues. Now, I didn’t expect to find it – atypical by its nature means there is no injury, trauma or disease that caused the condition. And, there are many reasons why your face would hurt.

The list of the first 20 were what you would expect: trigeminal neuralgia (several entries), TMJ, migraine. It was the next series of entries where the randomizing of the words “atypical,” “facial,” and “pain” got interesting. These included:

List of dog diseases

Other symptoms can include stunted growth and a ferret like facial … The atypical form and the form caused by abrupt withdrawal of steroids

List of Star Trek races

of initiating first contact was atypical; they brought other races to  Denobulan: The Denobulans are humanoid with facial ridges

Cherubism

disproportionate due to the fibrous tissue and atypical bone formation. the facial nerve as well as the zygomatic branch of the facial nerve.

When I added “chronic” the list got shorter; there was no generic description of atypical chronic facial pain. That’s the problem with a diagnosis that has a community of one; there’s nothing to hang your hat on, no list of symptoms and treatments, no organizations specifically targeting your health issue.

So, the sentence or three I would put in my entry:

Chronic Atypical Facial Pain: pain in the face not caused by any underlying trauma or disease. The severity of the pain can increase with time, use of the jaw in talking, chewing, smiling, position of the neck (can be related to impingement of nerves), and life. It can be treated with opioids, drugs for neuropathy (Lyrica), NSAIDs. The pain resembles a combination of several sensitive abscessed teeth with large cavities, a severely infected sinus, a black eye, and pressure like a thumb being scrunched down on the face. Trigger point injections, nerve blocks, acupuncture, massage, chocolate, white wine, and cheesecake are other methods that can be used for treatment. It is an invisible illness; there is no cure for this condition as there is no cause.

K, so white wine, cheesecake and chocolate would never be prescribed. But then, until I found my doctor in 2004, I also never met a health care professional who truly believed that my face hurt. She would no doubt agree with the chocolate!

While I was at it, I wikied “atypical chronic odontalgia” and I was surprised when I got an answer as part of a broader discussion about toothaches:

Atypical odontalgia is a form of toothache present in apparently normal teeth. The pain, generally dull, often moves from one tooth to another for a period of 4 months to several years. The cause of atypical odontalgia is not yet clear, although some form of nerve deafferentation is plausible.

I would add to this that a) the pain isn’t dull, it can be excruciating, b) lasts for many years (6 and counting), c) can affect multiple teeth at the same time, d) most pain medications do not work on this condition, e) is disbelieved by almost all health care and dental providers, f) if you have it, you are not imagining things or nuts; perfectly healthy teeth can feel like they need a root canal.

Tomorrow’s prompt: “Ekphrasis (writing about another art form) Post.” Find a Flickr image in Creative Commons that inspires you and free write about it for 15 minutes without stopping. “Brave bonus: publish it without editing![You can include a disclaimer])”

Oh boy, does that include typos from my fingers finding the wrong keys or writing words I wasn’t thinking about? I’m getting nervous already! Winking smile

the pain within/the pain without: living with chronic (clinical) depression


 

   

  

chronic pain and chronic depression: seems like down hill all the way

 

(Thanks to the ComLuv Enewsletter for this image!)
 

I know how the darkness feels; the shadows from the corners creep into the centre of the room. It’s hard to fight the darkness and the pain; they are intertwined like tendrils of some toxic, noxious invasive weed that lives by sucking all the life out of the host plant; depression smothers you the way that weed chokes out all other plants. It’s hard to fight both; but you are stronger than the evil twins of pain and depression. That you are here to write your blog is testament to that.
 

I wrote that on a friend’s blog who was dealing with both extreme pain and perhaps a deepening depression. For me, depression and chronic pain have always been the evil twins. I was sad before the monthly agony of PMS (perhaps I would be considered the new term for that) and its accompanying depression and pain; sad long before childhood headaches became teenage migraines; depressed long before the IBS-related chronic pain started in 1978; and I certainly was considered depressed by the time I stood in the grocery store line with the bag of potatoes and the chronic pain in my face began in 1998; down when my neck got worse in the early 2000s, and had begun the uncontrollable crying by the time of my painful teeth issues in 2005. Now, in 2010, abdomen, face, neck, teeth still hurt, and for a while on a new anti-depressant, I might not cry uncontrollably for hours or days.
 

(from Wikipedia: Dorothea Lange‘s classic picture, Migrant Mother of a depressed and worried mother during the Great Depression)
 

For others, depression is linked TO the chronic pain and the emotional as well physical issues it raises. In their discussion of depression and chronic pain, the folks at WebMD suggests that chronic pain leads to a feeling of constant stress because “[n]ormally, as pain subsides, so does the stressful response.” This emotional upheaval and turmoil mirrors many of the same feelings as depression:
 

Altered mood
 

Anger
 

Chronic anxiety
 

Confused thinking
 

Decreased self-esteem
 

Family stress
 

Fatigue
 

Fear of injury
 

Financial concerns
 

Irritability
 

Legal issues
 

Physical deconditioning
 

Reduced sexual activities
 

Sleep disturbances
 

Social isolation
 

Weight gain or loss
 

Work issues
 

According to some sources, as many as 50% of people with chronic pain also develop clinical (chronic) depression. Depression and chronic pain share some of the same neurotransmitters, as well as the same nerve pathways. It’s almost a catch-22: living with chronic pain can make you depressed; depression magnifies the pain and impacts on your coping skills. This interconnection both emotionally and biologically has lead many doctors to treat the two conditions as one using medications to dampen pain and improve mood and outlook. Antidepressants can work on a brain-level to reduce pain, while at the same time elevating the symptoms of depression. Initially, tricyclic antidepressants such as amitripyline and doxepin were used. These, however, came with a price: seemingly endless side effects. Newer antidepressants added to the medical mix include Cymbalta and Effexor. These are considered to have less side effects (see sidebar below) and with Effexor XR, an extended release 24 hour delivery system.*
 

{side bar: I linked back to the drug manufacturers who do list some of the side effects and in the case of Effexor XR have a co-pay coupon available and Cymbalta seems to be offering some sort of satisfaction guarantee; a caveat would be to search more broadly and see what comes up. I know, antidotally, that Cymbalta has some pretty wicked side effects and can be difficult to “come off” due to withdrawal symptoms. My experience with Cymbalta was that for a while, it helped with the crying, but like all anti-depression meds so far, it’s efficacy eventually wore off. I also found it didn’t do much of anything for the pain. I switched it out for another antidepressant in its class, so other than brain zaps, I transitioned okay. With Effexor xr, I had absorption issues: the extended release portion of each capsule wasn’t broken down by my small intestine thus limiting the usefulness of the drug. There was no clear way of knowing how much I took in, and the generic, non-extended release version did absolutely nothing for the depression.}
 

A quick search on several search engines for alternative medicine or alternative therapies and chronic pain and depression turned up no suggestions for a holistic approach to both. This is, I think, more a function of search terms than the lack of alternative or complementary medicines and therapies for chronic pain and chronic depression. Things like yoga, biofeedback, and tai chi immediately come to mind as potential crossover modalities (my big word for the day!).
 

So, with chronic pain and chronic depression, those evil twins, the invasive intertwining vines that can smother you if you don’t go on the offensive: machete cuts at the clinging tendrils; sweep away the cloying smell of darkness and agony; embrace bright sunlight in the new clearing you have created in the darkened forest of your “chronics.”** (thanks again to Wiki for the image of a woman doing Yang style tai chi)
 

* this is a very brief “technical/clinical” look at chronic pain and clinical depression, and by no means is an authorative discussion of either. It is mostly antidotal supplemented with a few quick searches on the web. There are blogs/websites devoted to providing you with good, relevant information. A great starting point is FM/CFS/ME Resources. A great site for chronic pain survivors, there are lots of helpful articles, including several on chronic pain and depression. FM/CFS/ME Resources suggests you also check out these websites for more on the topic, especially using behavio(u)rial and cognitive therapies to help with chronic pain and depression:
 

American Pain Foundation 

American Chronic Pain Association 

Academy of Cognitive Therapy 

Association for Behavioral and Cognitive Therapies  

Beck Institute for Cognitive Therapy and Research
 

** if you are wondering why this isn’t another descriptive piece on the evil twins, I just had a doctor’s appointment (still need to blog about) where my depression and pain meds were adjusted: so I’m on a new journey on the seemingly every winding road to pain and depression management. I have a feeling a descriptive piece on both is forthcoming!

Chronic Pain, The Huffington Post, and Comments Elsewhere

gracefulagony posted two interesting links: a HuffingtonPost article written by a doctor experiencing chronic pain for the first time. The doctor used a mix of traditional and non-traditional therapies to deal with his cancer-caused pain. His hypothesis that people in chronic pain are “situational narcissists” caused a stir when posted to a fibromyalgia community live journal site.  I’m curious about the:

I have also used an interesting technology for pain and anxiety management called The New Reality, Personal Achievement Device wich [sic] uses a combination of audio and visual stimulus to relive pain and control anxiety.

mentioned in Dr. Lipsenthal’s article. What exactly is this device? What does it do? 

Any thoughts, reactions, or comments?