Fibromyalgia and Temporomandibular Disorders

What's the connection between these painful conditions?

Dear Doctor,
Four years ago, I was diagnosed with fibromyalgia, and just recently I was diagnosed with temporomandibular disorder (TMD). I’ve heard it is not uncommon to have both conditions. What’s the connection between fibromyalgia and TMD?

Dear Noelle,
Both temporomandibular disorders (sometimes called TMD or TMJ) and fibromyalgia are painful conditions that can interfere with quality of life. Unfortunately, as you have found, people who already have one chronic pain condition often develop another one, or even more. In fact, many people newly diagnosed with TMD have previously experienced fluctuating pain in various parts of the body, suggesting a connection to fibromyalgia. And according to one study, three-fourths of fibromyalgia patients also have TMD. Yet many chronic pain conditions are known to occur together. What’s more, chronic pain conditions have shared characteristics that suggest common underlying disease mechanisms. With this in mind, let’s take a closer look at TMD and fibromyalgia.

TMD and Fibromyalgia Basics

Temporomandibular joint disorder is an umbrella term for a group of conditions that cause pain and dysfunction in the joint and muscles of the jaw. Typical symptoms include tenderness, tightness or pain around the jaw; problems with chewing and opening the mouth wide; and headaches and earaches. TMD can make ordinary activities such as yawning, eating or speaking difficult and uncomfortable. For many people, the painful symptoms go away on their own. But for some, the pain becomes chronic and debilitating. In these people, it is common to see co-occurring pain conditions such as fibromyalgia.

Fibromyalgia is characterized by widespread pain, aching and stiffness in muscles and joints. In many cases, it is accompanied by tender points on the body, headaches, muscle spasms and tingling sensations. People with fibromyalgia often report fatigue, sleep difficulties, mood disorders and memory problems.

Although both TMD and fibromyalgia can occur in males as well as females, these conditions are far more common among females, particularly among women in their childbearing years.

Where Does the Pain Come From?

For decades, doctors were puzzled when patients complained of pain that had no obvious origin—so much so that many physicians wondered whether their patients were imagining the pain they described. Fortunately, our understanding of chronic pain has grown substantially over the past two decades as we have learned more about how the nervous system transmits and processes pain signals.

The human nervous system is made up of two main parts: the central nervous system, consisting of the brain and the spinal cord, and the peripheral nervous system, which consists mainly of nerves. Peripheral pain can result when nerve cells are activated, such as when a person stubs a toe; it may also be caused by nerve damage in the body. When a person experiences jaw pain only once or twice, this may be an instance of peripheral pain rather than an indication of a chronic condition. In contrast, chronic pain conditions like TMD and fibromyalgia are believed to stem largely from defects in the central nervous system; they appear to be related to imbalances in neurotransmitters and pain-processing problems in the spinal cord or brain.

In chronic pain conditions, the central nervous system is thought to generate or amplify the sensation of pain even when nerve cells are not being stimulated. Several studies have found that people with TMD and fibromyalgia have increased sensitivity to pain compared with healthy people. This is borne out by brain-imaging technology: Individuals with chronic pain show more activity in brain regions associated with pain. In addition, scientists have identified specific genes linked to chronic pain conditions, including a gene pair that may explain why women are more likely than men to suffer from chronic pain.

Treatment

Before you consider treatment for TMD, your medical doctor should first rule out any other disease that may be causing your symptoms. If your physician does not diagnose a problem that is routinely treated by physicians, you may be referred to a dentist.

Your dentist may recommend a combination of the following simple practices to help relieve your symptoms:

• Eat soft foods
• Avoid hard chewing or extreme jaw movements
• Apply ice packs and moist heat
• Practice stress-reduction techniques

These tips can alleviate jaw discomfort whether the pain is short-term or chronic. In addition, your dentist may be able to show you some exercises to stretch or relax the jaw. The National Institute of Dental and Craniofacial Research and the American Association of Dental Research (AADR) and other experts agree that invasive or irreversible treatments for TMD, such as repositioning splints, grinding down teeth to bring the bite into balance, surgery or orthodontics that permanently change your bite, should be avoided where possible. If a doctor recommends surgery, be sure to ask about other options—and you may be wise to get a second opinion.

If you are already being treated for fibromyalgia, you may wish to discuss your TMD symptoms with your rheumatologist. Whether you seek care from a medical or dental practitioner, the National Institutes of Health suggests that you consult with a healthcare provider who is experienced in treating pain conditions that affect the muscles, bones and joints. When symptoms are severe and ongoing, the jaw is not functioning properly or there are co-existing conditions, treatment may involve a team of experts from different fields.

The more we learn about different types of pain, the better chance we have to provide effective and appropriate treatment for each individual’s situation. For example, we now know that opioids, in addition to their potential for addiction, are not effective in treating centralized pain conditions but may relieve severe peripheral pain. However, drugs that target neurotransmitter imbalances may be effective in the treatment of fibromyalgia and TMD. Cognitive-behavioral therapy may also be recommended since it has been shown to influence neurotransmission. Meditation and other pain-coping techniques may be helpful as well.

With continuing research, there is greater hope of helping those who suffer from TMD and other chronic pain conditions regain their quality of life through better pain management.