Abstract
Objective:The purpose of this study is to highlight the evidence of signs and symptoms of craniomandibular disorders (CMD) in patients suffering from fibromyalgia.Materials and Method:The study has been carried out from May 2011 to May 2015, recruiting a sample of fibromyalgia patients at the Department of Neurophysiopathology at the hospital Policlinico in Bari. Among the 150 examined patients, 60 of them have been diagnosed to suffer from fibromyalgia and 27 accepted to be investigated with a gnathologic examination at the Dental School at the University of Bari.Results:24 patients (88.9%) were women and 3 (11.1%) men; from 26 to 66 years old (average age, 39). 14 patients (51.9%) were affected by primary fibromyalgia, the remaining 13 (48.1%) by secondary fibromyalgia, mainly associated with hypothyroidism (29.6%). VAS average score was about 8 ± 1.85. The frequency of pain was daily in 15 patients (55.6%); twice a week in 10 patients (37.03%) and a few times a month in 2 patients (7.4%). 11 patients (40.7%) attributed the onset of fibromyalgia to a specific instigating event. In addition, from the gnathologic anamnesis, 11 patients (40,7%) reported a painful symptom in the head-neck region, especially in the frontal region, in the neck, in the masseter muscle and ATM. VAS average score was 3.4 ± 2.8, significantly lower than the one referring to the fibromyalgia pain. The gnathological examination found CMD signs and symptoms in 18 patients (66.7%). Concerning the prevalence of CMD, in type I fibromyalgia, myofascial pain was more frequent (5 patients), whereas in type II fibromyalgia, what was more frequent was a dislocation with reduction (3 patients).Conclusion:Based on clinic experience, we can affirm that some patients with CMD report pain in other regions. It is difficult to distinguish the CMD forms directly correlated to fibromyalgia from those engendered by parafunctional activities; hence the need is to resolve the fibromyalgia syndrome adopting a multidisciplinary approach.
Highlights
Fibromyalgia [1 - 3] is a form of extra-articular rheumatism or soft tissues rheumatism, characterised according to the American College of Rheumathology (ACR) [2], by at least 3 months of diffuse pain and tenderness in at least 11 of 18 muscle-skeletal points localised in nine regions of the body
We found that 67% of fibromyalgia patients showed signs and/or symptoms of Craniomandibular disorders (CMD), mainly referable to the sub-groups of myofascial pain (38,9%) and disc dislocation with reduction (22.3%); none of the patients resulted to belong to the third group
The pain can be further exacerbated by concurrence with stress and depression, which often is associated with fibromyalgia the patient, in most cases, tends to underrate craniomandibular problems perceived as of secondary importance and not associated with the main pathology
Summary
Fibromyalgia [1 - 3] is a form of extra-articular rheumatism or soft tissues rheumatism, characterised according to the American College of Rheumathology (ACR) [2], by at least 3 months of diffuse pain and tenderness in at least 11 of 18 muscle-skeletal points localised in nine regions of the body. We distinguish two types of fibromyalgia: primary. Fibromyalgia has a prevalence of 2%, mainly in the female gender (3.4% vs 0.5%) with an onset peak between 45 and 60 years of age [4]. Etiology of fibromyalgia is multifactorial [5]. Some are socio-cultural (high prevalence in low-income population, poor education level), depression, anxiety, muscle-skeletal pain and traumas
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