What is Fibromyalgia?
Fibromyalgia is a disorder that is difficult to diagnose and treat because its manifestations overlap with many other varied conditions like arthritis, depression, thyroid disease, etc. It is characterized by widespread musculoskeletal pain accompanied by depression, anxiety, fatigue, sleep problems and headaches. When firm pressure is applied to the painful or aching body parts, intense pain is elicited and these are called tender points. The patient is more sensitive to pain than others due to central sensitization, or a lower threshold to pain.
The exact cause is unknown, but gradual emergence of chronic pain is usually associated with a history of trauma, infection or a positive family disposition. Some people may have no known trigger. Women are usually affected, between the ages of 20-50 years.
TMJ and Fibromyalgia
The temporomandibular joint (TMJ) is the joint between the jawbone and the temporal bone of the skull. The disorder affects the joint and the muscles and cartilages around it, producing symptoms of pain around the face, neck and head, accompanied by headaches, difficulty in chewing, dizziness and sleep deprivation.
Just like fibromyalgia, TMJ disorder may be associated with a history of trauma or infection to the jaw, although there may also be no previous significant finding in the history. A lower threshold to pain also exists and the brain reacts to pain in a different way, producing symptoms that affect more parts of the body in general.
About 75-90% of fibromyalgia patients suffer from pain related to the TMJ. Most of these patients suffer from muscular TMJ disorder, the type which affects the muscles of chewing and involving the face, neck, scalp and shoulder. Symptoms include jaw pain and difficulty in chewing, headaches, dizziness and pain in the neck and shoulder. In contrast, the joint TMJ disorder which affects mostly the joint cartilage and ligament of the jaw is not usually associated with fibromyalgia. However, these patients may also experience headaches in addition to the jaw pain.
When TMJ is linked with fibromyalgia the pain and agony felt by the patient are increased; trigger points are also more sensitive. Treatment for TMJ and fibromyalgia includes the use of OTC oral analgesics and nonsteroidal anti-inflammatory drugs to decrease pain and inflammation. For muscle pain and tightness, muscle relaxants may be prescribed. Since the symptoms are usually non-responsive to pain medications and are associated with depression and sleep problems, antidepressants and anti-seizure drugs may be added to the regimen.
Medical and dental treatment may be frustrating. However, physical therapy may be helpful. Using cold and hot therapy to reduce pain and inflammation are recommended. Massage may be helpful but specific exercises for the jaw and neck are most important to increase mobility and improve jaw function. In serious cases, facial splints and TMJ surgery may be necessary to correct or repair anatomical defects like spurs, dental changes, etc.
In general, patients suffering from fibromyalgia also need to reduce and manage stress which can exacerbate their symptoms. Good diet, regular exercise and enough sleep may improve their health as a whole, thus improving perception of pain and reducing anxiety.
Mayo Clinic, “Fibromyalgia”, https://www.mayoclinic.com/health/fibromyalgia/DS00079
Fibromyalgia-Symptoms.org, “Temporomandibular Joint Disorder (TMJD)”, https://www.fibromyalgia-symptoms.org/fibromyalgia_tempero.html