TMJ Friends

Fibromyalgia is a disorder characterized by pain and stiffness, tenderness, fatigue, sleep disturbances, and muscle aches. Fibromyalgia patients may experience a wide range of symptoms. The most common areas of pain include: neck, back, hands, shoulders, and hips, however any body part can be affected.
Fibromyalgia means pain in the muscles, tendons, and ligaments.. the soft tissues in the body.
More women than men have fibromyalgia, but it affects people of all ages.

List of symptoms associated with fibromyalgia:
Pain: in one place or all over, with the exact locations being called “tender points.” Pain similar to that of arthritis, described as stiffness, aching, muscle spasms, and burning. The pain radiates, and varies depending on time of day, physical activities, weather changes, sleep, and stressful situations.
Sleep Disturbances: Almost all patients with fibromyalgia report problems with sleep and/or fatigue. Restless leg syndrome is also common.
Mood and/or Depression: Many fibromyalgia patients experience depression, problems with concentration, and mood disturbances.
Other symptoms: digestive problems (including irritable bowel syndrome, constipation, diarrhea), dizziness, headaches (migraine & tension), numbness or tingling in hands and feet.

How is Fibromyalgia diagnosed?
Like TMJ disorder, Fibromyalgia is difficult to diagnose since many of the symptoms mimic other disorders. Patients commonly see a family practice physicia or rheumatologist, who reviews their medical records and history to see if a diagnosis of fibromyalgia fits.
The doctor usually does a physical exam to see if tender points are present. To receive a diagnosis of fibromyalgia, a patient must have 11 of the 18 tender point sites. They also might do other tests, including blood work, x-rays, and MRI’s to rule out other problems.
Sleep tests are also common to help treat sleep problems.
Both TMJ disorder and fibromyalgia may take a patient years to be correctly diagnosed. Many physicians are not educated about TMJ disorder or fibromyalgia, or still may believe outdated theories regarding their validity.

What is the treatment for Fibromyalgia?
The cause of fibromyalgia is relatively unknown, so there is no cure. Treatment for fibromyalgia is usually centered around reducing pain and improving sleep. Since sleep is essential for many body functions (regulation of neurotransmitters, antibody production, tissue repair), it is very important to treat any sleep disorders since this might improve overall well being.

Like TMJ disorder, many fibromyalgia patients have found that a team approach utilizing many treatments is the most effective.
This can include:
Medications:
Pain: NSAIDs are usually not very effective, however many patients have found pain relief in opiates and ultram (tramadol). For more specific information on pain medications, please see the article “Pain Management 101.”
Sleep: Low dose tricyclic anti-depressants (elavil, imipramine, etc), Ambien, and clonazepam (klonopin) are often used at bedtime to help with sleep and restless legs.
Depression/Mood and Fatigue: Wellbutrin and SSRI’s (Prozac, Zoloft, Effexor) are often used for depression, while fatigue can be treated with Ritalin, Adderall, or Provigil. The latter, Provigil (modafinil), has been used often recently as it is more safe than other medications for fatigue, and can also improve depression, mental clarity (some fibromyalgia patients experience what they call a “fibro fog”), and attention deficit issues.
Trigger Point Injections: Injection with local anesthetic (procaine, serapin) can be helpful for tender points, as well as passive stretching with “spray & stretch” (ethyl chloride spray).
Exercise: Muscles that are not exercised are more prone to getting hurt and developing trigger points than those that are conditioned. Non-impact loading exercise is important and can also improve depression.
Support: Psychological support is important when dealing with any chronic illness. This can take the form of support groups like this one, counseling with professionals, in person support groups, and advocacy.

Other treatments that may be helpful:
Massage
Physical Therapy
Biofeedback
Acupuncture
Proper Nutrition
Relaxation Exercises

What causes fibromyalgia?
The cause of fibromyalgia is relatively unknown at this point, however there is research being done. Some physicians and scientists believe that many patient’s fibromyalgia was caused by an injury or trauma, while others believe that since sleep disturbances play such a large role in fibromyalgia, they might also have a part in its development. An increasing number of scientists believe that fibromyalgia has to do with irregular interpreting, processing, and transmitting of pain signals in the central nervous system. Fibromyalgia patients also may have low levels of chemicals in the brain, like serotonin and norepinephrine, which can cause depression and contribute to pain and fatigue.

Why do many people with TMJ disorder have Fibromyalgia, or many patients with Fibromyalgia have TMJ disorder?
There are many reasons, and although none have necessarily been scientifically proven, they are understandable because of common sense:
1. TMJ disorder and fibromyalgia are both disorders that are commonly seen in women between 20 and 50.. This increases the chance that you may have both if you are a woman and between these ages.
2. Both TMJ disorder and fibromyalgia effect muscles. Trigger points can be found anywhere - even in the TMJs. They are also found in the neck, shoulder and back which can contribute to TMJ discomfort.
3. Stress. This is controversial - does stress cause either problem, or do they cause stress (which exacerbates symptoms)?

No matter what the reason is that many patients have both TMJ disorder and fibromyalgia, it is undeniable that they are closely related. Patients have found that haing a multi-disciplinary team approach is the most helpful in treating both fibromyalgia and TMJ disorder.

If you have any questions or comments, please do not hesitate to post a question here or on our message board!