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Archive for June, 2012

20 Years of Pain Banished by a Dentist

June 29, 2012 3 comments

As clinicians dealing with chronic pain patients we spend a lot of time diagnosing TMD problems, guiding them through the various phases of treatment and trying to get them to change habits that have developed over a lifetime. It can be difficult to work out just what is happening while stomatognathic structures gradually heal and change, so that we can get a bit bogged down in our own concerns and lose sight of what the patient is also going through in these very challenging cases. We need to be equally aware of what the patient is going through and any psychological support they might require to help them through what can at times be a frustratingly slow process. I thought it would be useful to share a patient report that illustrates these points.

Nature's Appliance - tongue and cheeks acting to keep the teeth from touching

Nature’s Appliance – tongue and cheeks acting to keep the teeth from touching

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Complex Facial Pain Case; TMD, Trigeminal Neuralgia or NICO?

June 25, 2012 197 comments

It’s sadly the case that many of the patients I see on referral for chronic pain conditions have been all around the houses before they finally reach me, so I wanted to share a report from a patient with you that arrived by email this morning.

I don’t claim any extraordinary powers, but what I do do is to always approach every case as if it was my first, putting myself in a “beginner’s mind” state, then take a full and thorough history, carry out an equally thorough examination and come up with a preliminary diagnosis.

Having a “beginner’s mind” involves re-engaging in a way that can be difficult for people to do who have been doing the same job for many years. It’s all too easy to go into a kind of cruise-control mode because your mind has learned a skill so well that it means that most of the time your conscious mind can be off thinking about something completely different while still doing the job pretty well most of the time.

When it comes to trying to help patients who have already been in pain for a long time and have seen numerous practitioners, specialists and professors, you need to be fully engaged and in “learning mode”, as if doing it for the very first time. This is always going to be a case we can learn from; if it was simple someone else would have diagnosed it and fixed the problem ages ago, so we have to be in a learning mode, which invariably involves LISTENING to what the patient is actually saying and believing them when they tell you what their symptoms are. Read more…