One of the reasons "pain" is so often misdiagnosed is that "pain" isn't a very helpful description of what's going on. Different kinds of pain have different causes. You can have more than one kind of pain, but you will most likely have at least one, or maybe more than one, of these kinds of pain:
- Visceral pain is the pain we feel when our internal organs are injured or damaged. It's the generated by disease or injury to the organs in the "viscera," inside a cavity. This is the kind of pain that is generated by damage to the stomach, liver, gallbladder, urinary bladder, or intestines, or the muscles around them. It tends to be dull rather than sharp, spread out rather than focused, and squeezing rather than stabbing. It isn't impossible for this kind of pain to be referred to the left jaw, but it's rare.
- Somatic pain is generated by injury to the skin or the muscles. It can be caused by a trauma, such as surgery, or by factors that have been there a long time, such as inflammation, excessive activity, excessive stretching, repetitive stress or strain, spasticity, flabbiness, paralysis, use, or disuse. Somatic pain is also usually a dull pain that just doesn't go away. It's aggravated by activity and relieved by rest.
- Neuropathic pain is caused by injury to the nerves in the spine or to nerves in the peripheral nervous system. This kind of pain is felt as burning, tingling, drilling, stabbing, piercing, cutting, or "pins and needles" pain. Neuropathic pain usually occurs above the point of injury or nerve degeneration. Ordinary pain relievers don't help neuropathic pain, but antidepressants and certain drugs that manipulate neurotransmitters do.
- Psychogenic pain is the "all in your head" kind of pain. The mere fact that you are "imagining" the pain doesn't mean it isn't real. It is no less painful than any other form of pain. It simply originates in emotional or psychological distress rather than in physical disease or injury. Treating the emotional issues relieves the pain. It's possible to have psychogenic pain and neuropathic, Somatic, or visceral pain at the same time.
What does this mean for diagnosing jaw pain?
- If the jawbone is obviously dislocated or there is a lump in the jaw, the pain is not psychogenic. The doctor needs to treat the dislocation or the lump. "Lumps" may be caused by infection, cancer, non-cancerous tumors, or injury causing scar tissue.
- If the jaw is painful because muscles are tense, the problem may be myofascial pain dysfunction syndrome (MPD), which is usually believed to result from emotional stress. The treatment is to relieve the emotional distress.
- The jaw joint can be "internally deranged." In this case, "derangement" refers to the physical structure of the jaw joint, not a mental state.
- The surfaces of the joint can be damaged by arthritis.
- Dental infections can cause jaw pain.
- Ear infections can cause jaw pain.
- Migraine headache can sometimes cause pain in the jaw without causing pain elsewhere in the head.
- The mandible, either half of either jawbone, can be fractured or dislocated.
- Tick-borne diseases, such as Lyme disease, which additionally cause many other symptoms, can cause jaw pain.
When you're first concerned with jaw pain, it's probably a good idea to see either your dentist, if you have a history of gum disease, or your primary care provider. Even if your insurance coverage permits you to go to a specialist directly without a referral, see a generalist first. Specialists such as ENT's (ear nose and throat doctors) and orthopedists tend to look for diseases treated within their specialty, and may overlook problems that aren't in their area of expertise. Let your primary care provider diagnose the problem first, and then see a specialist.
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