Fibromyalgia and TMJ

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Temporomandibular joint disorder – or TMJ – results in pain and tenderness in the jaw joint, located on each side of the head just in front of the ears. This is the point where the lower jaw bone meets the skull. It’s hinge-like action facilitates talking, chewing, and yawning. Disorders of the temporomandibular joint can result from a number of different factors, such as arthritis, muscle fatigue due to grinding one’s teeth, or sustaining an injury to the jaw.

 There are a number of painful symptoms associated with TMJ, including: pain and/or tenderness in the jaw; dull, aching pain near (and possibly in) the ear; chewing difficulty; facial pain; difficulty opening and closing the mouth; clicking or grating sensation while chewing; headache; and an uneven or uncomfortable bite.

 The bones that comprise the temporomandibular joint are covered in cartilage and also separated by a small disk-like structure designed to absorb shock. TMJ can occur if the disk deteriorates or moves, if arthritis damages the cartilage, if the entire joint is damaged by a blunt force injury, or if the muscles that surround and support the joint become fatigued. For some individuals with TMJ, the exact cause is not clear.

 Nearly 35 million people in the U.S. suffer from temporomandibular joint pain, however the majority are women between the ages of 30 and 50. Those who were born with a deformity in their facial bones or dental structure are more likely to be affected. Also, TMJ is more common in individuals with rheumatoid arthritis, Fibromyalgia, chronic fatigue syndrome and sleep disorders.

 For some individuals with TMJ disorders, the symptoms will go away on their own. Others may require a bite guard to prevent teeth grinding. In cases where TMJ is made worse by stress and anxiety, cognitive behavioral therapy may be of benefit. Cognitive behavioral therapy is a type of psychotherapy that helps patients understand how their thoughts and feelings affect their body.

 Certain medications may also be useful. Painkillers (both over-the-counter and prescription) and muscle relaxers can help relieve the pain associated with TMJ. In the event of substantial pain and inflammation, corticosteroid injections or injections of botulinum toxin (e.g., Botox) may be needed. Certain antidepressant medications known as tricyclic antidepressants (examples of which include amitriptyline and nortriptyline) can be of benefit to some people as well. In extreme cases, surgery may be an option; however, the role and efficacy of surgery to treat TMJ is controversial.

 Both glucosamine sulfate and acupuncture have been investigated as natural therapies for treating the pain associated with TMJ disorders. Glucosamine sulfate has been demonstrated to be possibly effective, while more well-designed research studies are needed to adequately determine the effectiveness of acupuncture (Thie et al., 2001; Ernst & White, 1999). Lifestyle and behavioral remedies may improve symptoms as well, including eating soft foods, cutting food into small pieces, and avoiding chewy substances such as taffy and gum. Hot and/or cold compresses applied to painful areas may also help.

TMJ Disorder and Fibromyalgia

For those who have Fibromyalgia, a concurrent diagnosis of TMJ can make an already debilitating disease even more painful and limiting. Up to 90% of individuals with Fibromyalgia suffer from some type of jaw and/or facial pain, and some researchers have found TMJ to be present in as many as 41% (Wolfe et al., 2005) to 71% (Blasubramaniam et al., 2007) of patients with Fibromyalgia. These statistics suggest that Fibromyalgia and TMJ are somehow causally related, though more research is needed in order to fully determine their relationship.

A 2010 study by Velly et al. looked at the effects of Fibromyalgia and widespread pain on TMJ in 572 patients. Each patient underwent a physical examination at the beginning of the study to determine their diagnosis of TMJ-related pain. All subjects also received a tender point examination to help confirm the presence of Fibromyalgia. The authors found that 11% of the 572 subjects had Fibromyalgia and an additional 20% had widespread pain but did not qualify for a diagnosis of Fibromyalgia. This study further showed that individuals with Fibromyalgia and widespread pain had a greater risk of developing clinically significant TMJ-related pain (Velly et al., 2010). In a recent survey of 1,511 individuals with TMJ, Hoffman et al. found that one of the most frequent occurring comorbid conditions was Fibromyalgia. The authors suggest that further research into the frequent co-occurrence of Fibromyalgia, TMJ and other pain disorders may help researchers identify the causes of these conditions.

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References

1.      Blasurbramaniam R, de Leeuw R, Zhu H, Nickerson RB, Okeson JP, Carlson CR. Prevalence of temporomandibular disorders in Fibromyalgia and failed back syndrome patients: a blinded prospective comparison study. Oral Surg Oral med Oral Pathol Oral Radiol Endod. 2007;104(2):204-216.

2.      Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999;125:269-272.

3.      Hoffmann RG, Kotchen JM, Kotchen TA, Cowley T, Dasgupta M, Cowley AW. Temporomandibular disorders and associated clinical comorbidities. Clin J Pain. 2011;27:268-274.

4.      Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: a randomized double blind controlled 3 month clinical trial. J Rheumatol. 2001;28:1347-1355.

5.      Velly AM, Look JO, Schiffman E, Lenton PA, Kang W, Messner RP, Holcroft CA, Fricton JR. The effect of Fibromyalgia and widespread pain on the clinically significant temporomandibular muscle and joint pain disorders – a prospective 18-month cohort study. J Pain. 2010;11(11):1155-1164.

6.      Wolfe F, Katz RS, Michaud K. Jaw pain: its prevalence and meaning in patients with rheumatoid arthritis, osteoarthritis and Fibromyalgia. J Rheumatol. 2005;32:2421-2428.

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