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Abdallah AMA, El Fadly MAEA, Abdelfateh SMG, Taha MMS. Efficacy of Duloxetine With Arthrocentesis in the Management of TMJ Internal Derangement. J Craniofac Surg 2024; 35:1236-1240. [PMID: 38727210 DOI: 10.1097/scs.0000000000010266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 06/04/2024] Open
Abstract
Temporomandibular joint (TMJ) arthrocentesis is one of the most commonly used non-invasive surgical interventions in the treatment of refractory pain and dysfunction associated with internal derangement. Several adjunctive therapies have been used in combination with arthrocentesis in an attempt to increase its efficacy and long-term maintenance. Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor which is used in different chronic pain conditions. This study aimed to assess the efficacy of duloxetine in combination with arthrocentesis compared with arthrocentesis alone. Twenty-eight patients with chronic TMJ pain were included and randomly allocated into 2 groups (control and study groups). The control group included patients who underwent TMJ arthrocentesis only, and the study group included patients who underwent arthrocentesis followed by giving duloxetine (30 mg) orally twice daily for 3 months. Pain, maximum mouth opening, and level of anxiety and depression were assessed preoperatively and followed at regular intervals of 1 week, 1 month, 3 months, and 6 months postoperatively. Pain was significantly reduced in both groups at all postoperative intervals and was significantly lower in the study group than the control group at 6 months. Maximum mouth opening increased significantly in both groups, but the difference between them was not significant. Level of anxiety and depression was significantly decreased in both groups, with no statistically significant difference between them. The results of this study indicate that duloxetine in combination with arthrocentesis may provide effective and long-term pain control; however, its use is associated with a higher risk of adverse events.
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Al Sharie S, Varga SJ, Al-Husinat L, Sarzi-Puttini P, Araydah M, Bal’awi BR, Varrassi G. Unraveling the Complex Web of Fibromyalgia: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:272. [PMID: 38399559 PMCID: PMC10890445 DOI: 10.3390/medicina60020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Fibromyalgia is a complex and often misunderstood chronic pain disorder. It is characterized by widespread musculoskeletal pain, fatigue, and heightened sensitivity, and has evolved in diagnostic criteria and understanding over the years. Initially met with skepticism, fibromyalgia is now recognized as a global health concern affecting millions of people, with a prevalence transcending demographic boundaries. The clinical features and diagnosis of fibromyalgia encompass a range of symptoms beyond pain, including sleep disturbances and cognitive difficulties. This study emphasizes the importance of a comprehensive evaluation for accurate diagnosis, considering the shift from tender point reliance to a more holistic approach. Etiology and pathophysiology involve genetic predisposition, neurotransmitter dysregulation, central sensitization, and immune system involvement. Risk factors such as gender, age, family history, and comorbid conditions contribute to susceptibility. The impact on quality of life is profound, affecting physical and social aspects, often accompanied by mood disorders. Management approaches include pharmacological interventions, non-pharmacological therapies, lifestyle modifications, and alternative treatments. This study also delves into emerging research, exploring advances in neurobiological understanding, brain imaging, genetic markers, glutamate modulation, cannabinoids, gut microbiome, and digital health tools for fibromyalgia management. Overall, this study provides a nuanced and up-to-date overview of the complexities surrounding fibromyalgia, aiming to enhance understanding and support for individuals grappling with this challenging condition.
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Affiliation(s)
- Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
| | - Scott J. Varga
- Department of Neurology, OhioHealth Mansfield General Hospital, Mansfield, OH 44903, USA;
| | - Lou’i Al-Husinat
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Internal Medicine Department, ASST Fatebenefratelli-Sacco, University School of Medicine, 20157 Milan, Italy;
| | - Mohammad Araydah
- Department of Internal Medicine, Istishari Hospital, Amman 11942, Jordan;
| | - Batool Riyad Bal’awi
- Department of Family Medicine, Jordan Royal Medical Services, Amman 11855, Jordan;
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Lowry E, Marley J, McVeigh JG, McSorley E, Allsopp P, Kerr D. Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis. Nutrients 2020; 12:E2664. [PMID: 32878326 PMCID: PMC7551150 DOI: 10.3390/nu12092664] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.
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Affiliation(s)
- Ethan Lowry
- School of Health Sciences, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (E.L.); (J.M.)
| | - Joanne Marley
- School of Health Sciences, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (E.L.); (J.M.)
| | - Joseph G. McVeigh
- School of Clinical Therapies, University College Cork, Douglas Street, Cork T12 YN60, Ireland;
| | - Emeir McSorley
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, UK; (E.M.); (P.A.)
| | - Philip Allsopp
- School of Biomedical Sciences, Ulster University, Cromore Road, Coleraine BT52 1SA, UK; (E.M.); (P.A.)
| | - Daniel Kerr
- School of Health Sciences, Ulster University, Shore Road, Newtownabbey BT37 0QB, UK; (E.L.); (J.M.)
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De Stefano R, Bruno A, Muscatello MRA, Cedro C, Cicciù A, Rullo R, Gaeta M, Fiorillo L. Oral Health and Fibromyalgia Syndrome: A Systemic Review. J Funct Morphol Kinesiol 2020; 5:E7. [PMID: 33467223 PMCID: PMC7739237 DOI: 10.3390/jfmk5010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/13/2020] [Accepted: 01/17/2020] [Indexed: 12/12/2022] Open
Abstract
Fibromyalgia is a syndrome currently considered idiopathic and multifactorial rheumatic that causes an increase in muscle tension and is characterized by muscle pain and chronic fibrous tissues-widespread, fluctuating and migrating-associated with stiffness, asthenia, cognitive disorders, insomnia or sleep disorders, alterations in sensitivity to stimuli. In affected patients, there may be anxiety or depressive disorder development. The aim of this study is, with the help of an interdisciplinary team, to evaluate the correlations between this syndrome and oral health. A literature review was conducted, analyzing the most common scientific databases, more than 200 studies were obtained. Subsequently to the application of filters and revision by the authors, only 18 articles were considered eligible for this review. From the results, it is clear that the correlations between fibromyalgia and oral health mainly concern pain in the oro-maxillofacial district, especially in the temporomandibular joint. This certainly could help for faster diagnosis of the syndrome, which is currently difficult to identify.
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Affiliation(s)
- Rosa De Stefano
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina ME, Italy; (R.D.S.); (A.B.); (M.R.A.M.); (C.C.); (M.G.)
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina ME, Italy; (R.D.S.); (A.B.); (M.R.A.M.); (C.C.); (M.G.)
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina ME, Italy; (R.D.S.); (A.B.); (M.R.A.M.); (C.C.); (M.G.)
| | - Clemente Cedro
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina ME, Italy; (R.D.S.); (A.B.); (M.R.A.M.); (C.C.); (M.G.)
| | - Alessandra Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, School of Dentistry, University of Messina, 98100 Messina ME, Italy;
| | - Rosario Rullo
- Department of Biomedical and Surgical and Biomedical Sciences Naples University, 80100 Naples, Italy;
| | - Michele Gaeta
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina ME, Italy; (R.D.S.); (A.B.); (M.R.A.M.); (C.C.); (M.G.)
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, School of Dentistry, University of Messina, 98100 Messina ME, Italy;
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Ayouni I, Chebbi R, Hela Z, Dhidah M. Comorbidity between fibromyalgia and temporomandibular disorders: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:33-42. [DOI: 10.1016/j.oooo.2019.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 01/08/2023]
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Zwir L, Fraga M, Sanches M, Hoyuela C, Len C, Terreri MT. A case-control study about bite force, symptoms and signs of temporomandibular disorders in patients with idiopathic musculoskeletal pain syndromes. Adv Rheumatol 2018; 58:7. [PMID: 30657076 DOI: 10.1186/s42358-018-0006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purposes of this study were to assess the prevalence of temporomandibular disorders symptoms and signs and the bite force in pediatric patients with idiopathic musculoskeletal pain syndrome and to compare to healthy control individuals paired by gender and age. METHODS Forty consecutive patients (32 girls) from our outpatient pediatric rheumatology pain clinic with diagnosis of idiopathic musculoskeletal pain syndrome were included in this study. Twenty healthy subjects (16 girls) were considered the control group. All individuals were interviewed according to a standardized questionnaire concerning the presence of orofacial pain and functional impairment, and were submitted to a clinical evaluation following a structured protocol. After that the bite force was measured. RESULTS Twelve patients met the ACR criteria for fibromyalgia, and 28 presented the diagnosis of pain amplification syndrome. The mean age of patients was 13.1 years (range, 6-18 years) and of controls was 12.8 years (range, 6-18 years) with no significant difference. Orofacial symptoms occurred in 25 patients (62.5%) and in 3 controls (15%) (p = 0.0014). Sixteen (40%) patients and four (20%) controls presented pain during mandibular function with no significant difference. Although both pain groups presented separately more frequently orofacial symptoms and pain on palpation than the controls, maximal voluntary bite force was similar between patients and controls, between both patient groups and between the two pain groups and controls. CONCLUSIONS Our findings indicate that temporomandibular disorders symptoms were more prevalent in patients with idiopathic musculoskeletal pain syndrome than in healthy controls. However the bite force was not different among the groups.
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Affiliation(s)
- Liete Zwir
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil.
| | - Melissa Fraga
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil
| | - Monique Sanches
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil
| | - Carmen Hoyuela
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil
| | - Claudio Len
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil
| | - Maria Teresa Terreri
- Universidade Federal de São Paulo (UNIFESP), Rua Guilherme Moura, São Paulo, 95, Brazil
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Losert-Bruggner B, Hülse M, Hülse R. Fibromyalgia in patients with chronic CCD and CMD - A retrospective study of 555 patients. Cranio 2017; 36:318-326. [PMID: 28580880 DOI: 10.1080/08869634.2017.1334376] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Craniomandibular dysfunction (CMD) and craniocervical dysfunction (CCD) are clearly defined musculoskeletal pain syndromes. Relationships with fibromyalgia syndrome (FMS) have not yet been investigated. The aim of the present study is to establish possible relationships between FMS and CMD/ CCD. METHODS In a retrospective study, 555 patients with CCD and CMD were investigated with respect to the diagnostic criteria of FMS. In addition to otolaryngologic and dental examination, an instrumental functional analysis for the diagnosis of CMD/CCD was performed. RESULTS Three hundred fifty-one (63%) of the 555 patients evaluated met the diagnostic criteria for FMS. Seventy-two percent of the patients had a widespread pain index of at least 7 and a severity scale score of at least 5. Twenty-nine percent had a widespread pain index of 3-6 and a severity scale score of at least 9. Using myocentric bite splint therapy and therapy with oral orthesis in combination with neuromuscular relaxation measures, a good to very good improvement of physical symptoms was seen in 84% of CMD-FMS patients, and an improvement of the symptoms in the jaw was achieved in 77% of cases. DISCUSSION The substantial proportion of CMD and CCD patients who meet the criteria for FMS emphasizes the complexity of the two diseases. It must be assumed that FMS is a crucial factor for the formation of CMD and CCD. Conversely, CMD/ CCD could also be responsible for diverse clinical pictures of the FMS. FMS patients with synchronous CCD/CMD benefit from an interdisciplinary CMD/CCD treatment.
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Affiliation(s)
| | - Manfred Hülse
- b Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery , University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
| | - Roland Hülse
- b Section of Phoniatrics, Pedaudiology and Neurootology, Department of Otorhinolaryngology, Head and Neck Surgery , University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
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Schiffman E, Ohrbach R. Authors' response. J Am Dent Assoc 2016; 147:776. [PMID: 27688226 DOI: 10.1016/j.adaj.2016.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eric Schiffman
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, The State University of New York, Buffalo, NY
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