Fibromyalgia And Widespread Pain Effect on TMD Pain Disability Onset

Objective: Fibromyalgia and Widespread pain (WP) are indicated as contributing factors for temporomandibular disorders (TMD). The aim of this prospective cohort analysis was to identify the factors associated with the onset of TMD pain and disability, and to evaluate if these risks are modified by depression and gender.

Methods: Subjects data was obtained from the National Institute of Dental and Craniofacial Research TMJ Implant Registry and Repository (NIDCR TIRR), Etiology Study. Subjects were interviewed at baseline and at 18 months. TMD pain disability was defined as grades II to IV on the Graded Chronic Pain Scale (GCPS). WP was defined as pain present in 3 or 4 quadrants of the body, outside the masticatory system. A positive diagnosis of Fibromyalgia consisted of a complaint of WP and ? 11 tender points of 18 sites (American College of Rheumatology). Logistic regression analyses were adjusted by the effects of age, gender, depression, and baseline GCPS. Interaction factors were created among WP, Fibromyalgia and gender or depression.

Results: Among 272 subjects without TMD pain disability at baseline (Grade 0 or I GCPS), Fibromyalgia (odds ratio OR: 4.59, p=0.01), WP (OR: 2.87, p=0.008) and depression (OR: 2.81, p=0.04) were associated with the onset of dysfunctional TMD at 18-month follow-up. WP was related to the onset of grade II GCPS (OR: 2.39, p= 0.04) and grades III and IV (OR:10.44, p=0.04). Fibromyalgia was statistically related to the onset of grade III (OR: 25.50, p=0.002), but not grade II (OR: 3.19, p=0.10). These effects were independent of depression or gender.

Conclusion: The strong effect of Fibromyalgia and WP on the risk of developing pain-related disability among subjects who did not have pain dysfunction at baseline, was not modified by gender or depression. This study was funded by NIH/NIDCR grants # RO1DE11252 and # DE09737-09.