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Reny de Leeuw


The purpose of this study was to determine the prevalence of temporomandibular disorders (TMD) in fibromyalgia (FM) patients compared to failed back syndrome (FBS) patients. In addition, the FM and FBS patients were assessed and compared with regard to their psychosocial dysfunction. The study included 51 adult patients (FM = 32, FBS = 19) recruited from a physical medicine and rehabilitation clinic and a FM workshop. Questionnaires included an orofacial pain questionnaire and a battery of psychological questionnaires that included the Symptom Check List-90-Revised, the Pittsburgh Sleep Quality Index, the Multi-dimensional Pain Inventory, the Post-traumatic Stress Disorder Checklist-Civilian Version, and Multidimensional Fatigue Symptoms Inventoryshort form. Each patient underwent a clinical examination by a dentist who was blind to the diagnostic category and if applicable was diagnosed with TMD based on the Research Diagnostic Criteria for TMD. Fifty three percent of the FM patients reported having face pain compared to 11% of the FBS patients (P=0.002). Of those FM patients who reported face pain, 71% fulfilled the criteria for TMD. The psychometric data revealed that the FM patients had higher scores for somatization (P=0.02) and obsessive-compulsive (P=0.009) subscales compared to the FBS patients. The mean score of medication used to sleep was higher among the FM patients compared to FBS patients (P=0.002). Eighty seven percent of the FM patients reported a stressful event (P=0.036). Of those FM patients who reported a stressful event 42.3% were deemed post-traumatic stress disorder positive. FM patient also had higher scores for general fatigue (Pandlt;0.0001), emotional fatigue (P=0.008), physical fatigue (Pandlt;0.0001) and mental fatigue (Pandlt;0.0001) as compared to FBS patients. The high prevalence of TMD and psychosocial dysfunction among FM patients suggests a dysfunctional hypothalamic-pituitary-adrenal axis and dysregulated autonomic nervous system.