Pain is the body’s protection mechanism. We all experience it at one time or another. But how much do you really know about pain and where it comes from?

Much of it, you see, involves your teeth and your entire neuromuscular system.

There are two basic types of pain – short-term, also called acute, and long-term, or chronic.

An example of acute pain is a toothache. It lasts a short time and the pain experienced is in proportion to the severity of the stimulus. Once the stimulus is removed, the area heals and the pain goes away.

Jaw pain is an example of chronic pain. It lasts a long time at a lower intensity. The stimulus remains but its intensity is magnified by the brain’s response mechanism.

In acute pain, the brain processes the severity of the injury based on the amount of pain that is experienced – pain talks to your brain. When you cut your finger, the level of pain is usually less than when you put your hand on a hot stove.

The pain receptors in the hand send a message to the brain that the body is damaged or under attack. The brain then sends a message to the hand to quickly remove itself from the hot stove or whatever is the cause of the intense pain.

In chronic pain, the brain is constantly receiving messages of damage or attack. It’s a bit like being in a war.

Soldiers in battle are on alert and every message is heightened. The shuffling of feet or a car backfiring or the wind rustling leaves – they perceive these otherwise normal stimuli as signs of danger. Their response to low-level stimulus, therefore, is heightened.

In the same way, the on-going but low-intensity pain messages are perceived as much more intense than they actually would otherwise be. This is known as central sensitization.

Studies of the brains of chronic pain patients have shown structural and functional changes due to the modulation of pain perception. Because of this intense reaction, the touch of a feather can be perceived as intensely as a needle over the same area.

Over time, the size of the area in the brain that perceives pain becomes larger due to increased activity. Also, the area of sensitivity on the body tends to get bigger. If you have jaw pain, not only will the jaw be sensitive, but over time so will the surrounding areas such as the head and the neck, leading to headaches and neck pain.

Pain medication does not work well for chronic pain patients. The nerves that send and receive pain communication are surrounded by helper cells called glia. Pain medication works by calming the nerve cells, but they do not affect the glia. That means low-level pain continues to reach the centres in the brain that process it.

Let’s look at a specific case.

Leslie came to see me for a routine dental checkup and cleaning. As we went through her medical history, she told me that she’d suffered from headaches, jaw pain and neck pain for the last five years.

My examination revealed that Leslie’s head and neck muscles were not working in harmony with her jaws. As part of the treatment, I used computer analysis and the Myomonitor – which is a type of transcutaneous electrical neural stimulation unit, which we shorten to TENS.

I pressed her neck muscles and they were very tender. Even the lightest touch, in fact, made her wince. I first used the Myomonitor to relax her muscles so I could find the comfortable resting position of her muscles.

I then fitted Leslie with neuromuscular orthotic – a support system to allow her muscles to remain in that balanced position.

Over the next few months, I saw Leslie regularly, watching her progress. She started to tell me about the changes in the pain she was experiencing.

When she first came to see me, she reported her neck pain as being an eight out of 10 in intensity. But after three months, she said that the longstanding neck pain was no longer there – and that she had taken up ballroom dancing.

For many years, people with chronic pain were told: “It’s all in your head.” We now know that, in a sense, the diagnosis was right.

What is different is that sufferers of chronic pain need not feel guilty any more about their pain. Sure, it’s in your head. Literally.

A study by Dr. Barry Cooper and Dr. Israel Kleinberg confirms that chronic pain is psychological – but with a physiological basis. We also know how to get to the root cause and help the body back to equilibrium and health.



Dr. Sholina Kherani is a dentist with the Alberta Centre for Aesthetic Dentistry in Edmonton. Reach her with your questions and comments at drsholinakherani@shaw.ca.