Comorbid Conditions in Temporomandibular Disorders Myalgia and Myofascial Pain Compared to Fibromyalgia.

Golnaz Barjandi,Britt Hedenberg-Magnusson,Ana Miriam Velly,Eva Kosek,Malin Ernberg

doi:10.3390/jcm10143138

Abstract

The impact of comorbidities in fibromyalgia (FM) and temporomandibular disorders (TMD) have been well documented, but whether TMD sub-diagnoses myalgia (MYA) and myofascial pain with referral (MFP) differ regarding comorbidity is unclear. We aimed to elucidate this by studying the presence and associations of comorbidities in FM, MFP and MYA. An extended version of the Diagnostic Criteria for TMD axis II questionnaire was used to examine demographics, pain and comorbidities in 81 patients with FM, 80 with MYA, and 81 with MFP. Patients with MFP and FM reported a higher percentage of irritable bowel syndrome (IBS), depression, anxiety, somatic symptoms, perceived stress, and insomnia compared to MYA. Patients with FM had more IBS, depression, and somatic symptom disorder versus MFP. After adjusting for confounding variables, participants with anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater number of comorbidities, were more likely to have MFP than MYA, whereas FM participants were more associated with IBS, somatic symptoms and insomnia compared to MFP. The number of comorbidities was significantly associated with widespread pain but not pain duration, body mass index or being on sick leave. In conclusion, patients with MFP were more similar to those with FM regarding comorbidity and should be differentiated from MYA in clinical settings and pain management.

Highlights

Pain is a highly complex condition, defined as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ [1]
Musculoskeletal pain can present in different forms, including a wide-spread bodily pain as in fibromyalgia (FM) [4,5], or pain localized to a specific body region like the masticatory muscles in temporomandibular disorders (TMD) [6]
Significance is indicated by ** p < 0.01, *** p < 0.001. This cross-sectional study showed that participants with self-reported anxiety, somatic symptoms disorder, pain catastrophizing, and perceived stress, as well as a greater total number of comorbidities, were significantly more likely to have a TMD sub-diagnosis of myofascial pain with referral (MFP) compared to MYA

Summary

Introduction

Pain is a highly complex condition, defined as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’ [1]. It is a multidimensional phenomenon and perhaps more importantly, an individual experience, influenced by memories, cultural background and present life situations [1]. Musculoskeletal pain can present in different forms, including a wide-spread bodily pain as in fibromyalgia (FM) [4,5], or pain localized to a specific body region like the masticatory muscles in temporomandibular disorders (TMD) [6].

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