Chronic Pain Relief: Tension, Digest & Tinnitus

This week, we continue to chat without integrative doctors and specialists. Our guest this week was ENT Specialist Dr Jim Bartley. We discussed various subjects like chronic pain management, the three muscles which give the impression of sinus-type headaches, the power of breath, “rest and digest,” nitric oxide, the positive effects of humming, and tinnitus.

Tension Headaches, “Rest & Digest” and Tinnitus

Now, this week we continued our chats with the integrative doctors and specialists. If you thought that integrative, holistic doctors were just the domain of general practitioners, well, there are many specialists that I’ve connected with and spoken to, and I found them incredibly inspiring. 

This week’s guest was ENT Specialist Dr Jim Bartley from New South Wales. We covered a really wide range of topics, and it was so interesting to hear Jim. Well, one of the subjects we covered was chronic pain. 


This is an area that I’ve been interested in for my entire professional career and how I actually got into this more holistic approach focussed on stress because so many of the headaches that I ended up treating were what people had referred to as tension, normal tension, headaches or stress-related headaches.

For your information, I don’t believe there’s any such thing as a normal headache. I mean, we might get headaches once or twice a year from drinking too much or drinking too little. Some people, when I see them in the practise, will say, “Oh, I don’t get them very often.” 

Well, to some people, not very often means once a week, others mean once a month, and to others, it’s once a year. I would agree once a year is not very often, but certainly once a week or several times a week or even several times a month is not normal. There is a reason why these things occur. 

Often, headaches occur around the sinuses, either the frontal sinuses or the sinuses just below the eyes, just above the upper teeth, called the maxillary sinuses. People often think they are sinus headaches.

Chronic Pain Problem

Well, Jim reminded me and has been influenced by it, Dr Janet Travell. Now Janet Travell is a legend in chronic pain problems. She has written two textbooks on myofascial trigger points, and a trigger point within a muscle is a taut band within a muscle. Muscles are bands that move across each other as we contract and relax the muscle. 

You can get almost like a little knot or trigger point in the muscle, which will refer to the pain in a particular way. And Jim drew our attention to the fact that three muscles, in particular, give the impression of sinus-type headache.


Now, with those three muscles and just pulling these three out, there are deeper muscles that are also involved. The one on the shoulder that runs up the shoulder and attaches to the back of our head, to the base of the skull, is called the trapezius muscle. It refers to pain behind the eye, giving a sort of a frontal headache type of feeling. 

Another muscle running down from the base of the skull to the sternum is called the sternocleidomastoid muscle (CSM), which refers to pain across the front and around the temple and then around the maxillary sinus. This is another muscle that gives the impression of sinus headache. 

The other muscle that also is affected is the masseter muscle. When I clench my jaw, that muscle tightens, and it refers to pain in the middle ear and around just above the eyebrow, also giving the impression of a sinus-type headache.

These kinds of trigger points are often overlooked, in fact, often totally ignored. But in order to solve a problem, it helps to know what that problem is. The trigger points are a very common source of know what are described as tension headaches or stress-related headaches. The reason for those muscles being so susceptible is many reasons. 

One, if you clench or grind your teeth, not only do the muscles of the jaw tighten up, but as I clench my jaw now, my head doesn’t move. The reason my head doesn’t move is that not only do the jaw muscles tighten but so do the muscles. 

The sternocleidomastoid and the trapezius are both on the shoulder and around the neck, which stabilises the head when you clench your jaw or when you chew.

Posture and Various Technologies

Now they have quite a job to do in keeping our heads upright. If we have a head forward posture, as we do when we are looking at the computers, as we do when we’re looking down at various technologies, our phones, laptops, our devices, then those muscles come under strain as well. 

If you are a mouth breather, and this is where mouth breathing and posture come in, you need to maximise your airway. You tilt your head up to improve the airway, but you can’t walk around with your head tilted up. You have to keep your eyes parallel to the horizon. 

Instead of having your head tilted up, you move your head forward to keep your eyes parallel to the horizon. That results in a head forward posture, which puts a strain on the sternocleidomastoid muscle, and the trapezius muscle, which in turn refers to pain in what appears to be sinuses.

So I thought that was terrific that Jim, who was also involved in chronic pain management, was drawing that to our attention. And just as an aside, I mean, I was fortunate enough in 1989 to do a six-week programme with Dr Janet Travell. 

Now, I said she’s the legend. She used to be the physician for President Kennedy and President Johnson in the White House. Kennedy was a very unwell man who suffered from chronic pain. Not only did he have adrenal problems with Addison’s disease, but he had a lot of pain problems. Dr Janet Travell was credited with keeping him literally on his feet.

Now, when I had the pleasure, the privilege, and the honour of doing a six-week programme with Dr. Janet Travell in Washington, D.C., she was 92 at the time, a remarkable woman. That particular workshop, which, as I say, went on for six days, was 20 medical practitioners, physiotherapists and some dentists sitting in a circle around a big table in the middle of the room, which Janet Travell occupied and brought in one patient after another for six days and taught us how to take a medical history. 

Important Lessons

One of the most important lessons she ever taught me, and I still remember this and value this to this very day, is that if you ask your patients the right questions, they will not only often tell you what’s wrong with them, but they’ll also tell you how to fix it. That is a really important message. 

I was reminded of that in a recent podcast we did with Dr Sandeep Gupta, and he talked about the importance of validating and listening to our patients because so rarely, and we agreed that in less than 1% of cases, the problems are really just a bit psychotic. 

That’s so unusual. Most people who have a problem have a real problem, and they need to be listened to. They need to be heard. They need to be understood. I’ve been involved in chronic pain management for over 40 years, and often I hear the story that patients come in, they’ve been to see their doctor, they’ve been to see a neurologist, they’ve been to see a psychologist. 

They’ve been to see they’ve had X-rays, MRIs, and CAT scans. They’re in chronic pain, but they’ve been told nothing is wrong with them. What they really should have been told by that practitioner is, “I don’t know what is wrong with you.” Therein lies a very big difference. 

Janet Travell’s message of listening to your patients. If you understand anatomy and physiology, and that includes neurology and biochemistry, then what patients tell you is really revealing and very important in terms of establishing a diagnosis. 

It was great to talk to Jim about that. He also reminded us, and not surprisingly, because he’s written a book called Breathing Matters of the Power of the Breath, and in particular, the power to control our nervous system. Now, we hear a lot about stress. Of course, people are familiar with the fight or flight part of the stress response. 

That part of the nervous system that’s responsible for that is the sympathetic nervous system. That has protected us through periods of danger throughout our journey in evolution. It still does to this day. And the parasympathetic nervous system is that part of our nervous system which is rests and digests.

The problem today is that we are in sympathetic fight or flight mode too often. In fact, in some cases, all the time. Jim reminded us of the power of the breath to literally switch on the parasympathetic part of your nervous system, the rest and digest. Now, there are many times during the day when I think we could all benefit from stopping and using our breath. 

How easy, how accessible, how powerful that is because I think we can say we’re all breathing. You wouldn’t be listening to this if you weren’t. But utilising that breath to control your nervous system is something that I think is worth reminding you of in this Healthy Bite.


The way to do that is really simple. When we inhale, that is our sympathetic nervous system in action. When we exhale or hold our breath, that’s the parasympathetic nervous system in action. So a very simple exercise is to breathe in. 

Now, remember, breathing in through the nose is really important, and we’ll touch on that again. But breathing in through the nose slowly for three or 4 seconds, breathing out slowly through the nose for four or 5 seconds and holding the breath for a few more seconds. 

Let’s say three or four in, four or five out, holding for 3 to 5 seconds. That switches on the parasympathetic nervous system. If you do that four or five times, your nervous system will switch from fight or flight to the rest and digest. There are many times during the day when we feel that could be useful.

Of course, I think it’s a great time to do it just before you’re about to eat because if you eat under stress, the blood supply from your digestive tract is, during the stress response, diverted into your muscles. You could be on the best shot in the world, taking the best supplement in the world. If you are stressed when you eat, you will not be absorbing those nutrients. 

Switching on the parasympathetic nervous system just before you eat is a really good time to do that. Rest and digest and also just before you go to bed. I personally will lie in bed now. I put my snoring appliance on at night. I’ve put my microphone type on my mouth. I lie, I sleep on my side, but I rely on my back for one or 2 minutes. That’s 5 to 10 breaths. 

I will breathe in slowly for a few seconds, breathe out slowly for a few more seconds, and then hold my breath for a couple of seconds, and I will repeat that five or ten times. That was great that Jim reminded us of the power of the breath to switch on the parasympathetic. 

The other thing we touched on also was when nasal breathing, when there is an important regulator which any regular listener of our podcast will know is nitric oxide. Nitric oxide is one of nature’s, one of our bodies, most important regulators. It is a vasodilator. 

Reducing blood pressure is a bronchodilator meaning. It opens up airways. It is anti-microbial, and that includes anti-viral. When you breathe in through your nose, well, I’ve heard varying estimations, but somewhere between 60 to 90% of the body’s nitric oxide is produced in the paranasal sinuses only when you breathe through your nose. 

If you are looking for another important reason, not just warming, humidifying, and filtering the air before you take it into your lungs, but also to stimulate the production of nitric oxide, which all its with all its flow-on benefits, then nasal breathing takes on even more important than it did.

Interestingly, Jim reminded us of the power of humming and what a positive effect that has on body chemistry and the tone of the muscles in our throat. Remember, as we get older, the muscles in our pharynx become slacker. If we are a little bit overweight, that is exacerbated. 

They are major predisposing factors to sleep-disordered breathing conditions like snoring and obstructive sleep apnoea. So you see how this all ties in. This is what I call a holistic approach to health is all about. It’s not some new age philosophy just happens to be the way the body works. While we’re at it happens to be the way the planet works as well. 


We also touched on tinnitus, which is a really frustrating condition. Now, when I treat patients in my practise for headaches, neckache, and tinnitus, I will often say to them that the headaches and the neckaches are more than likely going to respond fairly quickly by addressing this clenching or grinding. That’s how I got involved in it, by addressing the clenching or grinding at night and taking tension and stress out of the muscles of the head and neck. 

Tinnitus is one of the more frustrating things for a patient and a practitioner to deal with. It was interesting because he made the point that it is also about stress and tension and trigger points and posture and that 80% of us, to some degree, get tinnitus. When you are in a quiet room, particularly at night as you are preparing for bed, tinnitus affects up to 80% of people at some stage. 

I thought it was really interesting that one suggestion was to put on really quiet calming music, you know, and you can sometimes press a sleep function where it will be on for ten, 15 or 20 minutes and turn itself off. 

I thought the discussion about tinnitus and chronic pain, and of course, Jim’s focus on vitamin D was also tremendous. The importance of vitamin D is something that we’ve discussed before. We’re going to do a whole programme on it together with thyroid function.

Now we’ve recently a podcast with Dr David Brownstein from Michigan in the US, who’s written extensively on thyroid function and iodine deficiencies. I mentioned thyroid function because of vitamin D and thyroid. 

There are receptors on every cell in the body of thyroid and vitamin D, and that is why the influence of vitamin D on all levels of health care is so critically important and why getting out in the sun in a responsible way is very important. As Jim pointed out, deficiencies in vitamin D result in high blood pressure, thyroid dysfunction, diabetes, colon cancer, and lung cancer. 

You know, the cancers that go on from vitamin D deficiencies are quite widespread. And yes, if we overdo it, we end up with melanomas. I go down to the beach, and I see well-meaning parents putting hats, broad-rimmed hats, and rash tops, which cover their child’s arms, bodies and legs. They have zinc on their face, so they have absolutely no exposure to vitamin D. 

I’m very pleased when I’m down on the beach with my grandchildren. They will often be running around with just their brief swimming costumes on and exposed to the Sun and good on them. They are wonderful, and they are healthy. I encourage I’m very pleased that my daughters take that approach, but they don’t allow them to burn. And there’s a big difference. 

I know when I was growing up, one of the things we did was get your first burn out of the way, once your skin peeled, once you were all set for the summer. That’s how we approached it. We even put coconut oil on our skin to get the brown going in even further. 

Actually, coconut oil would have had some benefits there, but we didn’t use the sun protection factor. I’m not saying that’s not important or necessary, but finding a balance is important, and sunshine is a really important part of our health journey, not only for the vitamin D but also for the effect it has on melatonin, setting this up for a good night’s sleep. 

There was so much covered. It was an opportunity for me to pull out those few little points that I thought were worth expanding on. I hope you enjoy the episode. I hope this finds you well. Until next time. This is Dr Ron Ehrlich. Be well.



This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.