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How Can the Valsalva Maneuver End Even EXTREME Pain?

December 27, 2013 · 72 comments

Pain from a wisdom tooth (left upper) had been getting worse every day. On the tenth day, I took no painkillers that morning and began documenting the pain.

A typical 5-minute episode that morning, using no painkillers:

Pain-Test-1

Though I almost never get headaches myself, I added what to me were more intuitive labels to a common 1-10 pain scale. The top line of my chart is a 9 on the common 1-10 pain scale, the bottom edge is zero.

To chart my pain, I used a ticking clock, and forced myself to sit down and make a tick mark on a chart every two seconds. I tried hard to hold still and not cry out, so I could get a better idea of how much my self control was affected. Without painkillers, my tooth was extremely sensitive to tiny, tiny changes in heat or cold, so I had to keep my mouth shut and my tongue over the area or a pain episode would start.

Why I Decided To Live With Pain

I had so far had a filling replacement that didn’t help, a consultation with two dentists, and another procedure scheduled. It frustrated me that no reference or professional seemed to understand clearly what caused that pain.

One benefit of at least trying to find options was that because there was no tooth next to the wisdom tooth, keeping it would mean I could keep chewing on that side. Neither a root canal (too much bone loss) nor an implant (too close to sinus cavity) were an option. Keep it or have it extracted were my only choices. And losing the ability to chew on one side meant challenges with TMJ, which I’ve had some difficulty with.

But mainly, this started because as I was talking to the two dentists, I just couldn’t help thinking: Why doesn’t anyone know anything about this pain? What if I could find something that would help? What if I could learn something about the pain that could help me solve the problem, and save the tooth, and maybe help other people? What I learned in the end was something that I would definitely have paid money to know.

So at first, I experimented with topical pain killers (eugenol/clove oil and benzocaine) combined with comparing acetaminophen to ibuprofen. But they didn’t help much, and pain got steadily worse each day. I never tried any opioid pain killers of any kind. I did try also try menthol on the skin near the pain (without any success).

How Much Pain?

In life experiences up to this point, I had learned I was more tolerant of pain than most people. Pain-sensitive people had at times told me I seemed almost masochistic (I’m not, though I loved hard physical challenges when I was younger).  However, I also learned that while more pain-tolerant women were rare, it wasn’t all that uncommon in men (which most studies bear out). So some some less pain-sensitive men might find me merely typical.

What I experienced went well beyond “severe pain.” The pain came in episodes of about 5 minutes each, 3-8 times/hour. Why 5-minute episodes? I have no idea.

At the dark areas in the peak shown above and below, it was really difficult to keep making tick marks. Sometimes I failed. I was not able to complete a chart in all cases.

Severe pain (dotted line on chart) was where I began to lose self-control, fidgeting, basically saying “screw this.” Up to that point I felt I had control, if only minimally. Beyond that point self-control was increasingly difficult. And  the pain pulsed a lot, making sharp, unpredictable increases in as little as a second or two, which was psychologically frustrating.

Here was another typical chart from that morning, caused by sipping warm water through a straw in tiny amounts (pain from “tooth temperature sensitivity”):

Pain-Test-2Since I was trying not to cry out, it was strange when I did (usually a short moan), almost like hearing myself without realizing it was me speaking.

The Surprising Solution “One Weird Trick:”

This was getting really, really difficult. But I charted another two similar episodes, and then a few minutes later, a fifth episode began. I had now been up nearly two hours at this point without painkillers. This last time, I had a long sneeze towards the end of the worst of the pain. In just a few seconds, virtually all pain disappeared:

Pain-Test-Sneeze

What had just happened? In fact, the pain had dropped faster than my ability to clearly chart it, basically ending in about 3 seconds. (There was also some additional mild pain during the 4-5 minute mark, but I stopped tracking at the 3.5 minute mark because of the surprising drop.)

During the next episode I experimented with trying to imitate “holding a sneeze,” and most of the pain was gone. This was miraculous!

Pain-Test-Continuous

At that point I had work obligations (I run a training and consulting business) and had to take some painkillers to get on with my full schedule that day. I did, but during the night, whenever I woke up, I experimented with different kinds of “sneeze holding.” My usual overnight pain then became virtually non-existent.

At first, I would hold my nose and blow like one might do to try to make their ears pop when changing altitude rapidly on an airplane. Sometimes I would also put my finger in my ear on that side to prevent popping. (These are basically modified Valsalva maneuvers /HT Doug Nakatomi.)

► The key seemed to be that I the air pressure I created in my sinus cavity relieved the pain by putting pressure on a nerve. Eventually I found I could just puff out my cheeks as I created exhalation pressure and that would do the trick. No nose holding.

The next morning, I had an early morning tooth extraction scheduled. I began charting my pain again, without taking painkillers, using the new technique. The first episode was remarkably pain free—never more than just “pressure!” (a “1” on the 1-10 scale). So I passed on my second opportunity to have the tooth extracted, and resolved to continue experimenting.

Over time, I began to have almost no episodes, and any small pain I felt could be easily eliminated (kept to less than “pressure”) with my ear popping technique. Not only that, episodes became much shorter, around 2 minutes. However, at first, if I didn’t take action, the pain could rise to about a 4.

But each day the pain became less frequent, and episodes shorter and milder. At first it was still hard to bite on the tooth, but after four days I am using it half normally. No pain or sensitivity at all at the end of the fourth day other than that I can’t yet bite down really hard on the tooth.

 

People Thought I Was Crazy To Try This

Frankly, in the first few days, after I began maxing out on ibuprofen, I felt I’d made a mistake. I had severe pain, and I wasn’t learning anything. I actually needed to hold off taking painkillers whenever I could, because it took so much to have any effect so that I needed to limit time spent on painkillers to keep my daily dose under control. So the final morning one of my motivations to document my pain was that I had to sit still without any painkillers to help anyway.

There were lots of family around (Christmas 2013) and people were very surprised I didn’t get the tooth extracted to (probably) end the pain. My wife was as supportive as she could be, but she didn’t agree with my decision to keep experimenting.

But it really irritated me that few people ever look into things like this. I had no reason to expect that I could affect my tooth pain, but if I could stand a few days of suffering to see if there was some way to save the tooth, and learn something about the pain, I was willing to try. And now I’m glad I did 🙂

Postscript: Dangers of Painkillers

Of course, acetaminophen (common brand: Tylenol) and ibuprofen (common brand: Advil) can land you in the emergency room if you overdose.  Acetaminophen in particular is really dangerous, with more than 1,500 people in the U.S. dead from accidental acetaminophen overdoses in less than a decade. And ibuprofen has a high risk of gastrointestinal ulceration, bleeding, and perforation. Always take it with food!

The problem is that acetaminophen’s fatal level is only a little higher than it’s recommended daily maximum, and it isn’t particularly good at attenuating tooth pain (neither is ibuprofen). This means it would quickly reach fatal levels if I were to take it “until the pain stops,” or if I thought acetaminophen was as safe as ibuprofen and took a similar number of pills.

Note: Someone asked “How did you make those charts?” I printed out a grid to mark on for tracking, then later photographed the result and photoshopped the area over the multi-colored gradient.

Also, my wife suggested I add this XKCD comic to describe my process:

20131231-212433.jpg

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