The natural history of pain; insights from toothache?
Joan had been working hard all week. No sooner had she returned from Oxford than she had to turn around and go to London for a meeting and then after a couple of days come down to Derbyshire. She had worked hard to keep herself together and part of that was making sure that her she brushed and flossed her teeth regularly. She had sensitive gums and had experienced severe toothache before. That made her worry about looking after her teeth. As a result she was an enthusiastic flosser when life was stressful. If her teeth were OK, so was she.
It was the day after some particularly vigorous flossing that her toothache started. Within a day, it had developed into a deep throbbing ache that made her feel sick and tired. Nevertheless she was determined to come to Derbyshire, but as soon as she arrived, she dipped and needed to rest and sleep.
Switching on the Christmas lights was one of the few occasions that the village gathered together. The Duchess even came over from the big house to officiate. Joan felt fine strolling through the village with the entourage to inspect the illuminations and she became quite animated talking to Wilma and Peter over supper. But when they left and she had time to think about it, the pain came back and she felt ill. She slept that night and was even well enough to go for a run in the morning, although breakfast set the pain off and the frustrations over buying Christmas lights at an overcrowded garden centre flared it up so much that she just put her head in hands and cried.
Toothache is like any other pain, back ache, headache or the pain of an irritable bowel. Joan’s experience illustrates how pain and other bodily symptoms can develop and fluctuate.
The surfaces of the mouth are covered with bacteria just like the colon and any breach may lead to a local infection, especially if the immune system is damped down by chronic stress. Inflammation or sensitivity in any part of the body can act as an alarm bell, not only reacting to immediate changes in the local environment, eating and drinking as far as the mouth is concerned, but also more generally to stress. Frustration, anxiety, pressure act via the sympathetic nervous system to increase pain transmission and perception. So when Joan was upset, the pain returned.
Alarm bells protect us. Then warn us of imminent danger and make us stop so that we don’t persist and do any more damage. When my knee hurts, I know I can’t run on it. But when there is no actual damage, as in IBS, the gut still behaves as if there is and tries to stop us eating and putting ourselves in situations that upset us and cause the gut to go into spasm. The trick is to decode the gut reaction and its trigger so that we can understand and either avoid or deal with it.
Joan’s experience illustrates not only the effectiveness of distraction in relieving the pain, but also how when the context or connotation is recalled, it returns.
Toothache is usually a self limiting condition and should go within a few days, but how much worse is the pain that twists your guts in knots and nobody understands. You don’t only have the torture of the pain to contend with but the fear that this may be due to a life threatening disease. Of course you would want to know what it is and if you didn’t know, you would at least want to have the confidence that you could get rid of it.
This is not impossible. You can be reassured that if your doctor has carried out appropriate screening tests, the chances are you don’t have a life threatening disease. And if you have been referred for a colonoscopy and it is clear, you should be doubly reassured. Severe gut pain does not necessarily mean the gut is damaged; often the fact that you are are worried and upset is making your gut sensitive and causing it to go into spasm and/or to trap gas. Then it’s a matter of experience and management.
So, be you own detective. Keep a diary or fill in The IBS Network’s symptom tracker. Note what situations or foods consistently make your symptoms worse. Try to avoid these or deal with them. Don’t be a victim; don’t dwell on the pain and misery; try to relax, take your mind off it and live your life in spite of it. A life threatening illness tends to show its hand pretty quickly, and if it is not life threatening, don’t let it take control. Gain experience. Get to know your illness, discover how to put it to one side while you get on with living, and, who knows, you may find as many others have, that it recedes into the background of life.
The Sensitive Gut 