Our good friend Wouter is back with another great story – thankfully nothing burned down this time around.
Last week I had an appointment with the dentist to extract a wisdom tooth – left lower jaw. Everything went as planned; some sedation, a pair of pliers and off he went. A few cracks and pops and the culprit was out. The dentist advised that I not rinse too much – the blood clot that forms in the hole is important as it protects the bones and nerves, and off I went.
First day everything is ok. Second day a little more pain, but everything is still ok. Experiencing some pain is not bad – it keeps you alert and reminds you not to chew on anything that could potentially damage the tissues further – or loosen the blood clot.
Day three – the pain gets a lot worse. I started thinking “I had an extraction that went “wrong” a couple of years ago – surely it’s not happening again?“
It is. I lost the blood clot.
Now I’ve got a condition called alveolitis osteitis or “dry socket”. It’s an inflammation of the socket where the tooth once resided – even writing up this little story with those words makes my jawbone more sensitive.
So, two things happened to me yesterday:
Firstly, I went to work and forgot my pain killers. The pain got bad, really bad. When it radiated to the whole left side of my face I got desperate and phoned home. My partner, how lovely she is, jumps in the car and brings me my stash of ‘dope’. Opening my mouth, swallowing the pills brings even more pain, but 5 minutes in and the pain subsides completely. “Damn”, I thought to myself, “the stuff isn’t even in my bloodstream yet and the pain is gone… Is our system conditioned to respond with immediate relief to ‘popping pills’ for pain or illness? Perhaps it is – my system seems to have learned, ‘the pill is in, I’m safe now, no more pain is needed…'”
Secondly, a few of hours later and the ‘drugs’ are wearing off. Another thought – “if just swallowing pills is enough to stop the pain completely, why do they ‘wear off”?” Anyway, the pain starts to come back. But now it’s not only the bottom left of my jaw, but also the top right – where I had a dry socket a couple of years ago… Why is my ‘brain’ doing this to me? That place healed up completely! Why pain there? Why does my brain ‘think’ there is danger coming from that area, there isn’t any damage…
In both cases it is clear that beliefs, expectation and past experience all play a big role in determining the level of ‘credible evidence of danger and safety’ in me, and my experience of tooth (and lack-of-tooth!) pain.
– Wouter Ramboer
Physiotherapist, West Flanders, Belgium
Wouter is a very active Twitter user and can be found by his Twitter handle @neuromanter, where he will be regularly posting links to some of the latest and most interesting articles related to pain and neuroscience, and discussing the future of the physiotherapy profession with others from around the globe.