How do Fibromyalgia and TMJ Disorders Relate?
by Dr. James Fricton
It is challenging for many people suffering from Fibromyalgia to assess what it may have to do with TMD Disorders.
Fibromyalgia (FM) and Temporomandibular (TMD) are two conditions that have a medical relationship to one another. It is not uncommon for a person who suffers jaw pain and headaches from TMD to also have fibromyalgia. Patients may find themselves dealing with both, which can make life and pain even more difficult to manage. Take courage, the Fibromyalgia TMD relationship is better defined today than ever before!
Fibromyalgia is a condition in which the patient experiences widespread muscle and joint pain throughout their body along with fatigue, depression, headaches, irritable bowel syndrome (IBS), insomnia, or restless leg syndrome (RLS).
What is the Fibromyalgia TMD relationship?
According to research lead at the National Institutes of Health, FM patients often have a high occurrence of TMD including both TM joint disk disorders and myofascial pain of the jaw, head, and neck muscles. TMDs are musculoskeletal conditions characterized by pain in the muscle of mastication, the temporomandibular joint, or both.
The NIH research found that “painful TMD, while more commonly experienced by females than males and declines in frequency after about people reach 45-50 years of age.” The most common type of TMD appears to be myofascial pain followed by disc displacement with reduction. Myofascial pain includes pain and tender knots called trigger points in the muscles of the jaw, head and neck.
For example, trigger points in the masseter muscles cause jaw pain, temporalis trigger points cause temple headaches, and the sternocleidomastoid trigger points cause neck and ear pain. TMD can cause these symptoms in patients with fibromyalgia.
The Minnesota Head and Neck Pain Clinic specializes in helping individuals who are suffering from persistent pain from both TMD and FM, which involves the jaw’s ability to function.
This article will help answer questions about how fibromyalgia (FM) and its relationship to painful TMD.
What is the relationship between TMD and FM?
Recent MRI studies of patients with TMD found alterations in the trigeminal nerve roots.
“Patients with TMD displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls displayed significantly lower FA higher MD and decreased GMV in the trigeminal nerve root compared with healthy controls”. The June 19, 2020 article entitled; “The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies” suggests that this discrepancy comes from the differences in duration and severity of pain.
When patients have delayed healing of TMD from risk factors such as teeth clenching, psychological distress tension, sleep disorders, and postural strain, the duration and severity of pain increases over a longer-term course of the illness. The assessment report involved people with TMD for four years or more.
According to the American College of Rheumatology, diagnostic criteria for Fibromyalgia, the prevalence of MB increased with age, with the highest values attained between 60 and 79 years. Like TMD, FM is also characterized by decreased pain threshold, sleep disturbance, fatigue, and is often accompanied with psychological distress. Early estimates (Fraga BP, Santos EB, Farias Neto JP, Macieira JC,
Quintans LJ Jr, Onofre AS, et al. Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients. J Craniofac Surg. 2012 Mar;23(2):615-8) suggested that more than 90% of fibromyalgia patients reported consistent facial pain and headache.
Many of these individuals are thought to suffer from TMD and today the number is growing. You can see how it becomes challenging to make a diagnosis unless you are an orofacial pain specialist. TMD affects how well the jaw functions, but it can also result in muscle pain throughout the head and neck area.
A key challenge for pain patients is that general dentists are often the first healthcare professionals to see people with orofacial pain (OFP). OFP conditions associated with the TMD are often confused with other dental disorders, which leads to mismanagement.
Fibromyalgia in painful Temporomandibular Muscle Joint Disorders
Many patients who come to our clinic with TMD report experiencing widespread pain and stiffness throughout their bodies. It may be directly due to FM but before seeking care, they have no definitive diagnosis. Becoming aware of what myofascial pain is opens up for a future of successful pain management. By diagnosing the persistence of chronic pain with or without dysfunctional TMD pain at the patient’s baseline, it is easier to determine a possible association between widespread pain and the onset of dysfunctional TMD.
Commonly, patients have been treated for painful TMD without consideration for FM. Fibromyalgia patients who experience local pain in the temples from the temporomandibular system often struggle with it for years before obtaining a clear diagnosis. It may follow the common pattern of being initiated in other parts of the body and later involving the temporomandibular region.
A significant positive correlation exists between TMD and FM. Patients with FM commonly are subject to suffering from headaches, facial pain, tiredness of the jaw, difficulties opening their mouths and chewing, as well as having a history of irritable bowel syndrome or premenstrual syndrome. Individuals with Fibromyalgia also commonly present this disease where the diagnosis of myofascial pain is more frequent.
The pain is frequently described as a “chronic dull aching pain” and is central to the diagnosis of both TMD and FM disorders. The most common diagnosis of TMD among patients with FM is masticatory myofascial pain (MP). Patients with FM most often have headaches and facial pain reflecting the overlap between the two. FM pain is often considerably more severe and spread over a larger body area than the pain found in patients with myofascial pain.
Follow-up appointments with your orofacial pain specialist will help you better understand your personal scenario and how treatment options may be tweaked.
How Tenderness is Measured for FM and TMJ Patients
Tenderness in FM is measured using “tender points”, while in MP and TMD they are termed “trigger points”. Increased hypersensitivity within your skeletal muscle, tendons, and ligaments will be monitored along with decreasing hypersensitivity. Our goal is to reduce the amount of pain you experience and help patients return to functioning normally.
Patients with FM may have lower pain thresholds and more pain, fatigue, sleep difficulty, functional disability, work difficulty, and general dissatisfaction with health compared to those with TMD. Every patient gains a personal diagnosis and treatment plan, since your pain’s intensity and location may vary based on which muscles are involved.
Localized tenderness is typically a reliable indicator of the severity of myofascial pain while widespread tenderness is a characteristic of FM patients. Many of the symptoms of FM such as fatigue, morning stiffness, and sleep disorders can also accompany TMD.
Individuals Predisposed to Temporomandibular Muscle Disorders and Fibromyalgia
A number of genetic studies on both TMD and FM help explain this tendency for increased tenderness and pain in the muscle tissues. The strain of the muscles such as clenching of the teeth may play more prominent roles in TMDJ whereas central factors may occur more in FM such as depression, anxiety, and psychological distress may occur more in FM. A person may be predisposed to TMD and FM through both genetic and environmental factors. Then, muscle strain may lead to localized ongoing increases in MP trigger points and referred pain.
Persistent pain in the facial region can also act as a stronger stimulus than pain elsewhere in the body. FM and TMD pain may coexist due to how a person’s central nervous system processes painful or stressful stimuli. “Functional pain” may be due to an altered function of the nervous system. When needed, our pain specialists are available to meet remotely to assess the development of additional pain complaints.
Stress appears to be a significant trigger in the onset and maintenance of both TMD and FM. Patients with both disorders may experience decreased responses to stressors such as social conflict and emotional reactions. Furthermore, Fibromyalgia patients have higher overall blood pressure levels and greater blood pressure increases to stress due to greater vasoconstriction.
Some muscle fiber types are functionally associated with static muscle tone and posture. They are slow twitch, fatigue-resistant muscles fibers used in energy metabolism. Type II muscle fibers can transform from one type to another depending on the demands placed on a muscle, especially if a person faces prolonged inactivity due to an injury. Inactivity and pain can decrease both the percent and size of the muscles used to maintain normal posture and resting muscle activity.
Pain and Associated Symptoms: Comparison between Fibromyalgia and Temporomandibular Disorder
Although being different clinical entities, FM and TMD are known to have common signs, symptoms, or associations.
However, the reason for pain is different due to the varying peculiarities of each disease. The importance of clinical investigation and multi-professional action aiming at preventing and/or minimizing painful symptoms is key.
In both TMD and FM, it is important to establish and maintain a healthy exercise routine. You can work with your physical therapist to avoid repetitive muscle strain factors. Your efforts can pay off by breaking or reducing tenderness and pain.
Understanding the Fibromyalgia TMD relationship and how to manage it.
Management includes exercises, direct therapy to muscles, and reduction of all contributing factors. The short-term goal is to restore the muscle and joints to normal function, posture, and full joint range of motion with exercises and muscle therapy. This is followed in the long term with a regular muscle stretching, postural, conditioning, and strengthening exercise program.
Long-term control of pain depends on reducing contributing factors through patient education, self-responsibility, and the development of long-term doctor-patient relationships.
We can help you with the task of changing your contributing factors and lessen your pain. You may benefit from an improvement in your outlook, lifestyle, and social and physical environment, as well. Our interdisciplinary team provides you with both training to reduce contributing factors and a supportive environment to accomplish long-term success in reducing TMD and FM pain.
“TMD is a local disorder and FM a generalized disorder, and there is less evidence of distress in those with TMD. TMD is a separate disorder from FM, but many patients with FM have TMD symptoms.” – The relationship between fibromyalgia and temporomandibular disorders: prevalence and symptom severity, NIH
“Although most cases of temporomandibular disorders (TMD) are mild and self-limiting, approximately 10% of patients develop severe disorders associated with chronic pain. It has been found that the widespread pain, depression, and sleep disorders associated with fibromyalgia (FM) may play a significant role in the chronicity of patients with TMD.” – James R Fricton wrote The relationship of temporomandibular disorders and fibromyalgia: implications for diagnosis and treatment for NIH
Although most cases of TMD are mild and self-limiting, about 10% develop severe disorders associated with chronic pain. It is also common that widespread pain, depression, and sleep disorders are associated with fibromyalgia. They may play a significant role in the chronic pain levels of patients with TMD.
We can help you learn if the symptoms of your chronic TMD have origins in FM. Our clinic understands the challenges of living with both disorders and leads nationally in better recognition and management of painful medical conditions.
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