Fibromyalgia: an update for oral health care providers

Surveying the International Prevalence and Nature of Eating, Drinking and Swallowing Difficulties in Adults Presenting with Fibromyalgia

Fibromyalgia is a centralized pain syndrome characterized by widespread pain, fatigue, sleep and sensory issues. Fibromyalgia is present in up to 8% of the global population, disproportionally affecting females. Research acknowledges that patients with similar rheumatic/neurological disorders experience eating, drinking and swallowing difficulties. There are also anecdotal reports regarding dysphagia among the fibromyalgia community. However, there is limited research exploring these issues, with potential impact on care delivery and patient outcomes. This study investigated the nature and prevalence of dysphagia in an international sample of adults with fibromyalgia. An online cross-sectional survey design was used to gather data. Questions were adapted from a criterion-based assessment and available evidence. The survey focused on demographics, dysphagia symptoms, and symptom experiences. Results were analyzed using descriptives and correlational analysis. 1983 individuals participated (age range: 18-94), located: Australia (n = 18), Ireland (n = 63), Canada (n = 174), New Zealand (n = 253), the UK (n = 434) and the USA (n = 1024). Many eating, drinking and swallowing symptoms were reported, including food sticking in the throat during swallowing (89%), and pills taking extra effort to swallow (88%), and dry mouth (85%). This study identified previously under-explored eating, drinking and swallowing difficulties among adults with fibromyalgia. These difficulties were self-reported across age, gender, and location, highlighting the potential prevalence of these concerns among a wide range of people, despite having not been explored in depth in previous studies. Timely and accurate dysphagia identification is vital given the its' potential impact on nutrition, prognosis and quality of life. This study highlighted the importance of honoring patient experiences in fibromyalgia management while also recommending input from allied health professionals such as SLTs and dietitians to improve therapeutic relationships and clinical outcomes. As such, continued research into the cause, implications, and management of these issues beyond is required to inform and optimise future patient-centred service delivery and care provision.

Increased Rates of Gold and Acrylate Allergy in Individuals with Fibromyalgia Tested with an Extended Dental Patch Test Series

Fibromyalgia is a common chronic pain condition. Rates of contact allergy in individuals with fibromyalgia have not been widely studied. Systemic contact allergy can present with muscle and joint pain and general malaise. The aim of this study is to investigate contact allergy rates in individuals with fibromyalgia to the sensitizers in an extended dental series and compare with control groups. Contact allergy to gold was significantly more common in the fibromyalgia group than the dermatitis control group. When corrected for patch test system, contact allergy to gold was significantly more common in the fibromyalgia group than the dental control group. Contact allergy to hydroxyethyl methacrylate and grouped acrylates and methacrylates was significantly more common in the fibromyalgia group than the dental control group. In conclusion, individuals with fibromyalgia may have a propensity to sensitization to gold, either via an increased exposure or an alteration in the oral environment. Gold is also implicated in systemic contact dermatitis and may be a factor in elicitation of symptoms in individuals with fibromyalgia. Acrylate allergy is also common in the fibromyalgia population and may be a consequence of occupational exposure or dental treatment.

The lived experiences of oropharyngeal dysphagia in adults living with fibromyalgia

BACKGROUND

Fibromyalgia is a chronic pain condition which has recently been linked with eating, drinking and swallowing difficulties (dysphagia). However, to date, sample sizes within completed research are small and study designs heterogeneous, and therefore, little is known about the lived experiences of dysphagia among people with fibromyalgia. To go some way towards addressing this gap in the literature, this study collected and analysed the first-hand experiences of the physical symptoms, the psychosocial impacts and environmental factors that influenced the lived experience of a sample of people living with fibromyalgia-associated dysphagia.

METHODS

Qualitative semi-structured interviews were conducted with adults with dysphagia and fibromyalgia. Reflexive thematic analysis was employed and themes were identified regarding the reported experience and impact of swallowing problems. The same researcher conducted the interviews and extracted all data, and a second researcher analysed a random sample of 5% of the data for accuracy, with no disagreements arising between the two researchers.

RESULTS

All participants (n = 8) reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia independently, primarily using compensatory strategies. Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature or impact of eating, drinking and swallowing difficulties. Participants also reported that they did not have access to evidence-based management strategies that adequately addressed their fibromyalgia-related swallowing problems.

CONCLUSIONS

Despite minimal previous research in this area, findings here highlight the impact that dysphagia has on people with fibromyalgia. A broad range of physical symptoms were reported to have negative consequences across both social and emotional domains. The reported symptoms often required complex coping strategies and sometimes impeded participants from seeking suitable medical intervention from healthcare providers. There are both broad-ranging implications of fibromyalgia-associated dysphagia and reported poor perceptions of medical interactions for this cohort of patients. Therefore, there is evidently a need for clinical research into the management of this condition to develop patient-centred care delivery options and to equip healthcare professionals with the knowledge and skills necessary to provide efficacious management to this group.

PATIENT OR PUBLIC CONTRIBUTION

Before initiation of the qualitative interviews, the interview schedule was piloted with an individual living with fibromyalgia and dysphagia, with feedback provided on the appropriate wording and format of semi-structured questioning.

Comprehensive Management of Rheumatic Diseases Affecting the Temporomandibular Joint

The temporomandibular joint (TMJ) is a synovial joint and thus is vulnerable to the afflictions that may affect other joints in the fields of rheumatology and orthopedics. Too often temporomandibular complaints are seen strictly as dental or orofacial concerns. Similarly, patients with known rheumatic disease may not have their TMJs included in routine screening and monitoring protocols. The purpose of this review is to highlight the rheumatic conditions likely to affect the TMJ and outline medical and surgical management in these patients with a focus on the need for continued patient reassessment and monitoring.

Fibromyalgia: practical considerations for oral health care providers

Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia. This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.

Is oral dysaesthesia a somatic symptom disorder?

Oral dysaesthesia is a condition characterised by persistent alteration to oral sensation, perceived by the patient to be abnormal and unpleasant, in the absence of mucosal pathology. Its aetiology remains uncertain. The condition was attributed as a psychosomatic disease for much of the 20th century, but with newer technologies, recent literature has mostly focused on a possible peripheral or central neuropathic aetiology to oral dysaesthesia. Despite this, psychotropic medications and psychological treatments remain forefront in the armamentarium for the management of oral dysaesthesia. This article aims to review the literature surrounding the pathogenesis of oral dysaesthesia and explore whether oral dysaesthesia is a somatic symptom disorder.

Case-control study of craniomandibular disorders in patients with fibromyalgia

BACKGROUND

Fibromyalgia is a clinical syndrome characterized by chronic widespread pain, which is non-articular and is predominantly experienced in the muscles and vertebral column, and by extensive heightened sensitivity to local pressure at many specific points The purpose of this study was to measure differences in the level of painful symptoms and in the movements of the mandible in a group of patients who had been diagnosed as suffering from fibromyalgia, in comparison with a control group. The anxiety and subjective pain levels and their relation with mandibular mobility were also compared.

MATERIAL AND METHODS

A case-control study was designed. The temporomandibular joints and masticatory muscles of the cases (n=20) and controls (n=18) were examined, anxiety was assessed by the STAI index and subjective pain was measured on a visual analogue scale. The data analysis was carried out with SPSS v.19.0 software. The descriptive data were expressed as means and proportions at a 95% confidence interval. The proportions were compared with the chi-square test and the means with the Mann-Whitney U test. Pearson's correlation coefficient was used to measure the association between quantitative variables.

RESULTS

The fibromyalgia patients (the case group) presented a higher level of pain following the musculoskeletal examination and significantly greater symptoms at the examination points. Regarding joint mobility, significant differences in mandibular opening were found (cases 43.4 mm vs controls 47.2 mm, p = 0.042). The mean pain score of the cases was significantly higher than that of the controls (4.03 vs 1.8, p = 0.001) but no significant differences were found in the anxiety index (23.8 vs 23.4).

CONCLUSIONS

patients with fibromyalgia are affected to a greater extent by craniomandibular disorders, with lower mouth opening and higher pain levels than healthy persons. However, the anxiety levels of the two groups are similar. Key words:Fibromyalgia, orofacial pain, temporomandibular disorder.

Pathophysiology of TMD pain--basic mechanisms and their implications for pharmacotherapy

This article discusses the pathophysiology of temporomandibular disorders (TMD)-related pain and its treatment with analgesic drugs. Temporomandibular disorders are comprised of a group of conditions that result in temporomandibular joint pain (arthralgia, arthritis) and/or masticatory muscle pain (myofascial TMD). In at least some patients with TMD, a peripheral mechanism contributes to this pain. However, there is often a poor correlation between the severity of TMD-related pain complaints and evidence of definitive tissue pathology. This has led to the concept that pain in some patients with TMD may result from altered central nervous system pain processing and further that this altered pain processing may be attributable to specific genes that are heritable. Psychosocial stressors are also thought to contribute to the development of TMD-related pain, particularly masticatory muscle pain. Finally, substantially more women suffer from TMD than men. Although there are arguably multiple reasons for sex-related differences in the prevalence of TMD, one candidate for the increased occurrence of this disorder in women has been suggested to be the female sex hormone oestrogen. Analgesic drugs are an integral part of the primary treatment for TMD-related pain and dysfunction with more that 90% of treatment recommendations involving use of medications. The most commonly used agents include non-steroidal anti-inflammatory drugs, corticosteroids, muscle relaxants, anxiolytics, opiates and tricyclic antidepressants, however, evidence in support of the effectiveness of these drugs is lacking. Continued research into the pathophysiology of TMD-related pain and the effectiveness of analgesic treatments for this pain is required.