Impact of Fibromyalgia Phenotype in Temporomandibular Disorders

Abstract

Background Mounting evidence suggests that central nervous system amplification, similar to that seen in fibromyalgia (FM), contributes to pain experience in a subset of patients with temporomandibular disorders (TMD). Methods In this prospective observational study, patients with TMD completed the 2011 FM survey questionnaire, a surrogate measure of “centralized” pain. The influence of centralized pain on TMD pain, dysfunction, and disability was assessed dichotomously by determining the incidence of FM-positive cases in the sample and by using FM survey scores as a continuous measure of “fibromyalgia-ness” (FMness). Results The patients meeting criteria for FM diagnosis (17 of 89) had significantly more disease burden on numerous measures. FMness was positively associated with pain at rest, negative mood, tenderness to palpation, perceived jaw functional limitation, and pain-related disability, and it was negatively associated with comfortable pain-free jaw opening. The impact of FMness on perceived jaw functional limitation and disability was mediated by levels of spontaneous, ongoing pain in the orofacial region. Importantly, this pattern of findings was still present even in those not meeting the criteria for FM diagnosis. Conclusion Together, these results imply that higher FMness increases TMD patient burden by amplifying spontaneous pain and further hampering painless jaw function, even in patients who do not meet criteria for FM diagnosis. These results are highly relevant for the clinical management of TMD, since they imply that targeting the CNS in the treatment of TMD patients with evidence of pain centralization may help ameliorate both pain and jaw dysfunction.

Association between nociplastic pain and premature endocrine therapy discontinuation in breast cancer patients

“…The Fibromyalgia Survey was proposed by the American College of Rheumatology in 2010 as a way to address this issue [28]. The instrument has since been validated for evaluation of bromyalgia, temporomandibular disorders, rheumatoid arthritis, and chronic lower back pain [1,2,11]. Studies have demonstrated an association between the Fibromyalgia Survey Score, pain, and disability, even when patients have a Fibromyalgia Score below the threshold for o cial bromyalgia diagnosis [2,11].…”

“…The instrument has since been validated for evaluation of bromyalgia, temporomandibular disorders, rheumatoid arthritis, and chronic lower back pain [1,2,11]. Studies have demonstrated an association between the Fibromyalgia Survey Score, pain, and disability, even when patients have a Fibromyalgia Score below the threshold for o cial bromyalgia diagnosis [2,11]. Our study found that in patients with breast cancer, an increased Fibromyalgia Score prior to surgery is associated with ET discontinuation, with most patients discontinuing their ET due to side effects.…”

Topology of pain networks in patients with temporomandibular disorder and pain-free controls with and without concurrent experimental pain: A pilot study

“…The reduction in inferior frontal surface area, as well as the negative associations currently observed between ACRFS total and WPI scores and corticospinal tract volume, and between hypervigilance scores and pre- and postcentral grey matter volume, may also comport with previously published observations that orbitofrontal grey matter thickness and primary motor cortical thickness are negatively associated with pain unpleasantness and duration, respectively ( 25 , 106 ). Higher ACRFS scores were recently shown to be associated with higher levels of clinical pain, functional limitation, and disability and also with reduced responsiveness to arthroscopy of the temporomandibular joint in TMD patients ( 55 , 56 ). These central findings could help explain why the clinical pain picture is often more complex in patients with higher fibromyalgianess.…”

“…TMD is one of several chronic overlapping pain conditions believed to be driven, at least in part, by central nervous system alterations. Fibromyalgia is considered by most to be a prototypical nociplastic pain condition, and higher “fibromyalgianess” scores have been found to be associated with more complex pain mechanisms and poorer outcomes in TMD and other chronic pain conditions ( 53 – 56 ). Therefore, in addition to the comparisons between pain and pain-free groups, we also assessed whether TMD patients degree of likely nociplastic pain (assessed with the fibromyalgia survey criteria) is correlated with the degree of central nervous system changes.…”

Neuroimmune signatures in chronic low back pain subtypes

“…"fibromyalgianess") in individuals who meet criteria for fibromyalgia 59 and individuals with other pain disorders who do not. 60,61 PET For all patients from both protocols, PET data were corrected for radioactive decay, deadtime, variable detector sensitivity, random coincidences, photon attenuation and scatter using software provided by the manufacturer or developed in house. Attenuation correction was performed using an MR-based approach developed in house.…”