COMMENTARY

Orofacial Pain and Fibromyalgia: What's the Connection?

Eric T. Stoopler, DMD

Disclosures

November 16, 2012

High Prevalence of Orofacial Complaints in Patients With Fibromyalgia: A Case-Control Study

da Silva LA, Kazyiama HH, de Siqueira JT, Teixeira MJ, de Siqueira SR
Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:e29-e34

Study Summary

Fibromyalgia syndrome is often associated with widespread rheumatologic, neurologic, and psychological effects. Patients commonly suffer from fatigue, chronic musculoskeletal pain, sleep disturbances, psychological distress, and associated neurologic phenomena.[1] Patients with this condition often complain about orofacial pain that can affect a variety of structures in the head and neck. A recent study conducted by da Silva and colleagues investigated orofacial complaints and characteristics of patients with fibromyalgia syndrome compared with controls.

The study enrolled 25 consecutive patients (24 women, 1 man) with fibromyalgia syndrome who fulfilled the criteria established by the American College of Rheumatology for diagnosis of this condition.[2] The control group consisted of 25 healthy sex-matched patients who did not meet diagnostic criteria for fibromyalgia syndrome. Orofacial evaluations were performed by a single researcher and included documentation of standard demographic data and completion of a standardized protocol for evaluation of pain in the orofacial region. This included detailed questioning on pain characteristics, medical history, medications, earache, headache, generalized body pain, sleep disturbances, and masticatory complaints. Examination of each patient consisted of palpation of the muscular structures of the head, neck, and masticatory system; a periodontal examination; and evaluation of all intraoral structures.

Data analysis did not reveal any differences in findings of dental and intraoral examinations between the 2 groups. However, the fibromyalgia group exhibited the following characteristics in higher frequency compared with controls:

  • Temporomandibular disorders;

  • Generalized pain on awakening;

  • Fatigue complaints in the orofacial region;

  • Pain caused by mandibular movements;

  • Number of painful areas upon palpation of the head and neck; and

  • Complaints of earache, headache and sleep disturbances.

Viewpoint

Individuals with fibromyalgia syndrome routinely present to dental professionals for oral healthcare needs, and orofacial pain complaints may be part of the constellation of symptoms reported by these patients. Temporomandibular disorders are common in the general population but appear to be expressed at a higher rate in patients with fibromyalgia syndrome and may have a significant impact on oral health as well as general well-being.[1,3] At this time, it is unknown whether orofacial complaints represent a comorbid condition associated with fibromyalgia syndrome, and the cause-effect relationship between these 2 conditions requires further investigation.[1,3] Oral burning sensations seem to be prevalent at a higher frequency in patients with fibromyalgia syndrome and may be correlated with neurologic phenomena such as central hyperexcitability.[1] Future studies will provide a deeper understanding of the relationship between orofacial pain complaints and fibromyalgia syndrome.

Dental providers must have a clear understanding of the systemic effects of fibromyalgia syndrome because it can affect the provision of care. For example, patients with fibromyalgia syndrome who have diffuse musculoskeletal pain may have difficulty maintaining a comfortable position in the dental chair while receiving treatment. Medical treatment of fibromyalgia syndrome often includes pharmacologic agents to manage various aspects of the condition. These agents can have significant implications for oral healthcare, increasing risk for xerostomia or interacting with other medications used in dentistry.[1] Patients may present for routine dental care with orofacial complaints without a diagnosis of fibromyalgia syndrome, and the astute clinician should not hesitate to refer a patient to the appropriate healthcare provider for further evaluation if an underlying fibromyalgia syndrome diagnosis is suspected.

Abstract

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