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Articles • Arq. Neuro-Psiquiatr. 74 (3) • Mar 2016 • https://doi.org/10.1590/0004-282X20160017 copy

Temporomandibular disorders in fibromyalgia patients: are there different pain onset?

Disfunção termomandibuar em doentes com fibromialgia: há diferença no início das dores?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify temporomandibular disorders (TMD) symptoms in two groups of fibromyalgia patients according to the temporal relation between the onset of facial pain (FP) and generalized body pain (GBP). Cross-sectional study design: Fifty-three consecutive women with fibromyalgia and FP were stratified according to the onset of orofacial pain: Group-A (mean age 47.30 ± 14.20 years old), onset of FP preceded GBP; Group-B (mean age 51.33 ± 11.03 years old), the FP started concomitant or after GBP. Clinical assessment Research Diagnostic Criteria for Temporomandibular Disorders and the Visual Analogue Scale.

Results

Myofascial pain with mouth opening limitation (p = 0.038); right disc displacement with reduction (p = 0.012) and jaw stiffness (p = 0.004) were predominant in Group A. Myofascial pain without mouth opening limitation (p = 0.038) and numbness/burning were more common in Group B.

Conclusion

All patients had temporomandibular joint symptoms, mainly muscle disorders. The prevalence of myofascial pain with limited mouth opening and right TMJ disc displacement with reduction were higher in Group A.

fibromyalgia; orofacial pain; facial pain; temporomandibular disorders

	Group A (n = 20)	Group B (n = 33)	p
FP complaints	12 (60%)	22 (66.7%)	0.624¹
Facial and intra-oral pain complaints	8 (40%)	11 (33.3%)	-
Headache complaints	17 (85%)	29 (87.9%)	1.000²
FP in the morning	14 (70%)	26 (78.8%)	0.522²
Morning fatigue/stiffness	13 (65%)	26 (78.8%)	0.270¹
Unconfortable bite	13 (65%)	28 (84.8%)	0.174²
Mean FP VAS at the exam	5.45 ± 2.50 (0-10)	5.39 ± 3.13 (0-10)	0.753³
Mean FP VAS at the crises	8.55 ± 1.73 (4-10)	8.79 ± 1.41 (5-10)	0.706³
Mean FP VAS at the last 6 months	6.60 ± 2.21 (3-10)	6.55 ± 1.84 (3-10)	0.926³
FP onset (years)	13.21 ± 11.39 (1.2-45)	7.13 ± 7.45 (0.25-36)	0.021³
Body pain onset (years)	5.78 ± 4.05 (1-15)	12.76 ± 10.53 (1.25-36)	0.014³

	Group A (n = 20)	Group B (n = 33)	p
Location
Masseter	6 (30%)	5 (15.2%)	-
Pre-auricular	1 (5%)	9 (27.3%)	0.130¹
Angle of mandible	1 (5%)	3 (9.1%)	-
Temporal area	1 (5%)	0 (0%)	-
More than 1 area	11 (55%)	16 (48.5%)	-
Side of facial pain
Right	1 (5.0%)	4 (12.1%)	-
Left	2 (10.0%)	5 (15.2%)	0.694¹
Billateral	17 (85%)	24 (72.7%)	-
Descriptor for facial pain
Fatigue	6 (30%)	13 (39.4%)	0.489²
Stiffness	12 (60%)	7 (21.2%)	0.004²
Throbbing	6 (30%)	6 (18.2%)	0.335¹
Shock-like	4 (20%)	6 (18.2%)	1.0001
Numbness/Burning	5 (25%)	18 (54.5%)	0.035²
Others	5 (25%)	17 (51.5%)	0.058²

	Group A (n = 20)	Group B (n = 33)	p
Myofascial pain without limited mouth opening	4 (20%)	16 (48.5%)	0.038¹
Myofascial pain with limited mouth opening	16 (80%)	17 (51.5%)	0.038¹
Right TMJ Arthralgia	10 (50%)	21 (63.6%)	0.329¹
Left TMJ Arthralgia	10 (50%)	20 (60.6%)	0.450¹
Right TMJ Osteoarthrosis	2 (10%)	2 (6.1%)	0.627²
Left TMJ Osteoarthrosis	2 (10%)	4 (12.1%)	10.002
Right TMJ Osteoarthritis	5 (25%)	6 (18.2%)	0.728²
Left TMJ Osteoarthritis	4 (20%)	3 (9.1%)	0.405²
Right disc displacement with reduction	11 (55%)	7 (21.2%)	0.012¹
Right disc displacement without reduction	0 (0.0%)	0 (0.0%)	-
Left disc displacement with reduction	6 (30%)	9 (27.3%)	0.831¹
Left disc displacement without reduction	0 (0.0%)	0 (0.0%)	-

	Depression			Non-specific physical symptoms

	Group A (n = 20)	Group B (n = 33)	p*	Group A (n = 20)	Group B (n = 33)	p*
Normal	1 (5%)	5 (15.2%)	-	0	1 (3%)	-
Moderate	5 (25%)	7 (21.2%)	0.633	2(10%)	3 (9.1%)	1.000
Severe	14 (70%)	21 (63.6%)	-	18 (90%)	29 (87.9%)	-

	Group A (n = 20)	Group B (n = 33)	p*
Low pain and incapacitation	2 (10%)	5 (15.2%)	-
High pain, low incapacitation	11 (55%)	13 (39.4%)	0.397
High incapacitation, moderate limitation	6 (30%)	8 (24.2%)	-
High incapacitation and limitation.	1 (5%)	7 (21.2%)	-

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