Lip pain solution?
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Greetings all, I am a damaged (ex ? ) trumpeter...I had been playing, trumpet and Fluegel regularly, mostly in "church rock bands" for over 30 years...
long story short, lip strain?/overuse? (orbicularis Oris) injury whilst playing (felt it happen) 12 years ago. End of lips both sides. I have had ongoing pain since then. It only pains if I talk, sing, whistle smile etc. Need to limit talking to only several short conversations per day. I am sick of taking analgesics and applying Xylocaine anaesthetic cream when it gets severe. If I remain in a "vow of silence" the pain subsides. I have not played since injured, very sad indeed ....I have sought solutions/remedies all over the world for last 10 plus years, MRIs and ultrasounds show no abnormality and there has been no surgery or obvious physical damage. I have had countless consults and discussions in person and via phone and web with Drs, professors, Neuros etc etc ... latest attempt to reduce pain was taking gabapentin, the small amount of relief was not worth the side effects of taking it.. The next (last?) throw of the dice is my Neurologist wants to try small botox injections at end of lip area... any one any thoughts? ideas? advice? experience??..
I do thank Steven very much for his thoughts on matter, over last couple of months. I just thought I would cast the net out again as I imagine the botox effects (side effects) will last at least 3 months.
Whilst I have taken up guitar and bass, which I do enjoy, it just doesn't "cut the mustard" with what you can express with a horn
To be pain free and normal again is the goal.. to play again would be an amazing bonus..
Thanks for taking the time to read my plaintive plea
Take care
stay well, God Bless Doug -
@sessionaire
So sorry to hear of your plight, Doug. I am in my eighties and did lose the ability to play for about 3 weeks after a case of overuse and I thought I was through, but it was not as serious as your situation and within a month I was playing again. But I don't push my luck anymore and listen when my chops are telling me to back off.I do hope you find an answer. I would go bonkers if I couldn't play my horns.
George
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This post is deleted! -
I am certainly NOT for Botox. If a proper doctor has looked at you and there have been ultrasound/CRT/MRT whatever pictures taken to insure that the muscle tissue is properly attached at both sides, I would recommend calling Dave Monette. No, not for a new mouthpiece or trumpet, rather for his advice as a CST/Feldenkrais/yoga practitioner. We screw our bodies up in thousands of small steps and I believe the path back (barring serious physical damage) is also with small steps. I do not believe that "brute force" massages are the solution, although they can sometimes result in temporary relief.
I have helped people back to playing and speaking after strokes, and after an accident that has now resulted in full dentures for me, have also found my way back.
The small steps approach may sound esoteric, but I assure you, it is not. -
@rowuk I second that opinion.
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@sessionaire said in Lip pain solution?:
Greetings all, I am a damaged (ex ? ) trumpeter...I had been playing, trumpet and Fluegel regularly, mostly in "church rock bands" for over 30 years...
long story short, lip strain?/overuse? (orbicularis Oris) injury whilst playing (felt it happen) 12 years ago. End of lips both sides. I have had ongoing pain since then. It only pains if I talk, sing, whistle smile etc. Need to limit talking to only several short conversations per day. I am sick of taking analgesics and applying Xylocaine anaesthetic cream when it gets severe. If I remain in a "vow of silence" the pain subsides. I have not played since injured, very sad indeed ....I have sought solutions/remedies all over the world for last 10 plus years, MRIs and ultrasounds show no abnormality and there has been no surgery or obvious physical damage. I have had countless consults and discussions in person and via phone and web with Drs, professors, Neuros etc etc ... latest attempt to reduce pain was taking gabapentin, the small amount of relief was not worth the side effects of taking it.. The next (last?) throw of the dice is my Neurologist wants to try small botox injections at end of lip area... any one any thoughts? ideas? advice? experience??..
I do thank Steven very much for his thoughts on matter, over last couple of months. I just thought I would cast the net out again as I imagine the botox effects (side effects) will last at least 3 months.
Whilst I have taken up guitar and bass, which I do enjoy, it just doesn't "cut the mustard" with what you can express with a horn
To be pain free and normal again is the goal.. to play again would be an amazing bonus..
Thanks for taking the time to read my plaintive plea
Take care
stay well, God Bless DougWhere do you live? Just curious if there is a trumpet professor nearby you could consult with.
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I am a physician, Please understand, Botox is for muscle disorders. As you so noted, MRI and US were negative. That means there is no motor unit dysfunction causing the pain. In fact, paralyzing muscle (Botox mechanism of action) runs the risk of irritating the neurological dysfunction that is the cause of the pain.
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Now read on:
Botulinum toxin will treat muscle stiffness and spasm. Botox can reduce inflammation as the mechanism of pain relief. This is an acute process, as I have read into the OP's experience, the injury occurred 12 years ago. It is unlikely that this relief of an inflammatory condition by paralyzing impinging muscle is active this far out from the initial injury. Botox injections work by causing involved muscles to release tension, which then blocks the stimuli for the nerves to induce pain.
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@sessionaire
Thank you all for your time and contributions. My location approx 2 hours from Sydney.
And yes I know it is impossible to diagnose/recommend in absentia 10,000 miles away.
I am just looking for someone who may have had to walk the same journey...
A bit more history...to explain why I am at my wits end..a) I have spent an incredible amount of $$$ and time in travelling probably 20 or more times to Sydney for consults basically a 6 hour round trip incl a consult.
b) Previously I have seen 3 other Neurologists at the professor level, and facial pain Clinic professor,
these have tried baclofen, Lyrica gabapentin and perhaps others that I cannot recall,
c) TENS machine and xylocaine
d) also a PhD physio professor who specialises in rehabbing brass musos in symphony orchestras using ongoing speciality exercises etc specifically, no change.e) When visiting Chicago in 2011, I spent 2 hrs with one of the best known trumpet players/teacher there who said my technique was fine.
f) 2 x 10 week long sessions of acupuncture with 2 different practitioners,The most recent MRIs and Ultrasounds have been in the last 10 months.
g) A cosmetic/plastic surgeon (one of the best in the nation) has recently offered to do exploratory surgery... but why would I want to create additional scar tissue??
h) learning more about anatomy I believe the junctions/connections between the Orbicularis Oris and Buccinators on both sides were damaged?? producing scar tissue? trapped nerves?
i) the latest Neurologist that I am currently consulting with tried me on Gabapentin for 2 months with dose as high as 300mg 3 times per day with minimal impact and unacceptable side effects.
He has suggested botox as he uses a lot with good results for migraine sufferers.sorry to waffle.. but this is the bullet point summary..
I struggle to talk any more than a few short conversations per day and if above that then need to resort to paracetemol and xylocaine.
hence my frustration and interest in trying botox.. no one can offer me anything , buzzing a mouth piece etc and doing "restorative" exercises are not practical/possible.
Thanks for your comments Dr Go, I am torn....thanks all
Doug -
Do you find areas that are painful to pressure? Does pressure there create any other areas of pain? With pressure can you then contract the muscles?
Are there any areas of numbness? When you look in the mirror are there drooping areas? When you purse your lips, again in the mirror, is the contraction symmetrical? If not what do you see? We'll start there.
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@richard-iii
Thanks Richard
Nothing sagging.
Not painful to pressure except when it is already sore. Can contract muscles whilst pressure applied.
When not sore or painful there is no numbness.
After a lot of talking etc when it gets sore then there is a slight feeling of numbness, tingling etc in top lip (moustache area), dimple area when gets worse can spread to lower lip and vaguely into chin area.
Sorry Its a bit hard to be very specific at minute as I talked a fair bit yesterday (out with brother fishing) and still paying for it this morning (being about maybe 12- 16 hrs in front of you in US)
thanks for your interest
best wishes
Doug -
@richard-iii
Richard
symmetrical when purse lips/form embouchure.
thanks again
Doug -
Thanks for the answers. Most concerning is the numbness/tingling. If that were absent I would suggest a number of physical therapies. However, due to the neurological involvement and the location of the possible entrapment I am concerned greatly. Without getting into cranial nerve distribution, if you had entered my office with these complaints, I would refer you to a facial specialist in neurology. I think the answer is out there. I would not go to a generalist as this area requires its own specialization. You might be facing some surgery. Best of luck.
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@richard-iii said in Lip pain solution?:
Thanks for the answers. Most concerning is the numbness/tingling. If that were absent I would suggest a number of physical therapies. However, due to the neurological involvement and the location of the possible entrapment I am concerned greatly. Without getting into cranial nerve distribution, if you had entered my office with these complaints, I would refer you to a facial specialist in neurology. I think the answer is out there. I would not go to a generalist as this area requires its own specialization. You might be facing some surgery. Best of luck.
Richard, I agree, the neurologist is best qualified to determine the etiology, and then and only then, recommend therapy.
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@dr-go
Thank you Richard and Dr Go
The neurologist I am seeing is the 4th. 2 of the other 3 were professors. This last one has tried the gabapentin and he is suggesting that the next least invasive thing is some very small botox injections. Having looked at MRIs etc he suggests that exploratory surgery runs great risk in further irritating nerves that are sending the pain signals.Believe me I have searched the web, including emailing with a neuro prof in germany , one at Mt Sinai NY etc etc and knocked on pretty much every door available to me, even trumpet professors in US but everyone shakes their head in unbelief saying can't help, never heard of it, too hard.
Thanks again
Doug -
@sessionaire Just contact Dave Monette. Just talk to him. Maybe you do not even need a doctor. Maybe he even knows someone in your area that could take a completely different view of the issue. https://www.davemonette.com
Jennifer Montone - solo horn with the Philadelphia Orchestra was in a car accident and damage to the hips immobilized her embouchure - no, not spine damage. Your root problem may have nothing to do with these serious symptoms. You may also want to watch this carefully:
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@sessionaire said in Lip pain solution?:
(orbicularis Oris) injury whilst playing (felt it happen) 12 years ago
While I do not disagree with Rowuk, that many physiological disabilities may impact on embouchure performance, in the case of the OP, it appears as a direct injury to the muscle as the OP says in his initial post that (...injury whilst playing (felt it happen) 12 years ago).
I also agree that contacting Dave Monette is also a good place to go toward recommended experts in the field that may be able to help, but would recommend focusing on a direct injury to the orbicularis Oris muscle. I found the best medical report possible that details an experienced clinician's perspective that has cared from multiple cases of orbicularis Oris damage. I do not subscribe to this journal but perhaps you can find a library that will get the full article for you or contact the clinician directly to get their opinion as well.
https://pubmed.ncbi.nlm.nih.gov/8656963/
Hope all this advice gets you the new hope that I believe you are seeking from opening this thread. I do believe that coming to TrumpetBoards was a good decision as there are a lot of good people here that have the expertise to guide you, musicians as well as physicians... including a couple physician musicians.
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Question for the OP that I should have asked in the first place. Was there any sign of visible bruising after the original injury?
