Getting Cozy with Chronic Pain

A few years ago I read an article in the New York Times written by Lena Dunham, the writer, and star of the sitcom, Girls. In the article, entitled, Call Me Cozy, she describes her challenge of living with chronic pain and how, because of it, she takes the cultivation and preservation of comfort very seriously.

The article got me thinking about my patients. As you know, my practice is focused on treating people who suffer from chronic pain in the face, jaw, and head – often due to muscle fatigue and spasms, temporomandibular disorders, and neuropathic mechanisms associated with peripheral and central sensitization.

Through my own experiences and what I learn by reading the scientific literature, it is quite evident that stress in the daily lives of my patients has the capacity to disrupt muscle and joint physiology, lower pain thresholds, and activate the neuroimmune system predisposing to chronic pain conditions.

So where does all this stress come from?

When you walk down the streets of New York City, it is easy to be reminded that our lives are lived at a frenetic pace. Everyone you pass seems to have an urgent mission to accomplish, no matter what the price. Jaywalking was once considered risky behavior, but today, people cross the street in traffic with their eyes glued to a phone or a phone glued to their ear. Even more dangerous.

And, this frenetic pace doesn’t end when they get home, either. The temptation to stray from the task at hand is ever-present – whether it be a work task or something done just for fun.

Today, our minds and bodies are in perpetual motion. Downtime is limited. Fatigue is common.

So, if cozy is defined as a feeling of comfort, warmth, and relaxation, it is easy to see why it’s become so elusive.

Beyond life’s daily challenges, which can seem superficial in nature and minimally impactful on the body and mind, consider the fact that many people also struggle with anxiety, anger, and loneliness. And others, many of whom were subjected to trauma at an early age, constantly deal with the repetitive re-living of the trauma, often daily.

Anxiety, anger, loneliness, and the effects of trauma all have an impact on the body. The sense of being in danger all the time has been proven to increase cortisol and adrenalin levels in the bloodstream and activate the fight-or-flight system.

How does the feeling of being in constant danger cause pain and muscle tightness?

The brain reacts to danger by reducing blood flow to multiple body regions leading to a decrease in tissue oxygen levels. This, in turn, leads to biochemical changes in muscles as irritants such as lactic acid accumulate, fuel nerve excitation and lead to lowered pain thresholds…

…precisely the condition of most of my patients when they first arrive at my office.

Unfortunately, it’s not easy to avoid these biologic insults, particularly when the source of danger is ever-present and often unforgettable. Although life’s stresses have confronted every generation, the challenges in front of us today seem to be more invasive, more penetrating, and most importantly, inescapable.

To make matters worse, video cameras are everywhere, recording our every whereabouts. Text messaging and emails demand answers with immediacy and are inescapable. Instagram and Snapchat fill some people’s lives with snapshots of what others are doing 24/7 – often making them feel left out or jealous.

Technology can clutter, replace, introduce urgency, and disrupt whatever calm is present in life. This is real and concerning.

Today, finding cozy is difficult, if not impossible.

Many patients who arrive at my office to seek relief from jaw and facial pain are just like most people – constantly barraged by life’s stresses. They don’t have the time, or the ability, to find personal space or a moment of quiet that could help maintain the proper balance and calibration to maintain normal pain thresholds. This holds true for every age group – including teenagers.

Cozy, for them, is unattainable – and the stress lands in their jaws.

So how can we help our chronic pain patients find cozy today?

Though not so easy, with an effort to dedicate time every day, there are strategies that are time-tested and work. Whether it’s mindfulness meditation, focused efforts to control and slow breathing during the day (Buteyko breathing), Tai Chi, restorative yoga, guided imagery, or progressive muscle relaxation techniques, there are choices that can make that a real difference in easing body tension.

It’s not always possible for our patients to escape life’s predicaments and traumatic memories, but we can help them change how their bodies react to these stressors on an everyday basis. It is important to remember that healing is a process – not an event. When the brain is given an opportunity to turn down the volume on how it responds to stress, daily pain experiences can be reduced.

I welcome your thoughts.