Perceived helpfulness of treatments for myofascial TMD as a function of comorbid widespread pain

Abstract

Objective: This study examined whether patients with myofascial temporomandibular disorder (mTMD) comorbid with fibromyalgia (FM) receive different treatments or respond differently to these treatments than mTMD-only patients.

Materials and methods: A total of 125 mTMD+ women were enrolled (26 FM+ and 98 FM-). mTMD and FM were assessed via clinical research examinations. Treatment histories and self-reported treatment-related improvement were obtained via interview.

Results: The top 3 most common treatments reported were oral appliances (59%), physical therapy (54%), and jaw exercises at home (34%). Use of alternative medicine was reported more frequently among FM+ women, but self-reported improvement did not differ by comorbid FM. Physical therapy was as likely reported by FM status but self-reported improvement scores trended higher for FM+ women.

Conclusions: Oral appliances were as likely to be reported by FM comorbid as FM- women. Oral appliances did not outperform self-management treatments on self-reported improvement of facial pain.

Clinical relevance: Results support the use of self-management as first-line treatment for mTMD and potential utility of inquiring about widespread pain for treatment planning.

Keywords: Facial pain; Fibromyalgia; Self-reported improvement; Temporomandibular disorders; Widespread pain.

Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1

Self-reported improvement in facial pain by treatment and disorder status. The proportion of women reporting that treatment helped at least a little did not differ significantly by treatment or comorbid disorder status. Maximum number of subjects reporting each treatment (by all mTMD, mTMD only, mTMD+WSP, mTMD+FM, respectively): oral appliances, 72,45,27,14; jaw exercises, 44,24,20,10; trigger point injections, 17,9,8,4; physical therapy, 68,34,34,17; TENS, 10,4,6,3; chiropractic, 21,7,14,6; acupuncture, 25,10,15,7. mTMD = myofascial temporomandibular disorder; WSP = widespread pain inclusive of any FM diagnosis; FM = fibromyalgia clinical research diagnosis; TENS = transcutaneous electrical nerve stimulation; helped = dichotomized as “helped a little” or “helped a lot” vs “did not help”, “made pain a little worse” or “made pain a lot worse

Fig. 2

Comparison of self-reported facial pain improvement: oral appliance vs. self-management treatments. a Among women reporting one or the other, the proportion of women reporting that self-management helped was greater than proportion of women reporting oral appliance helped (*p value < 0.01). b Among women reporting both types of treatments, difference did not reach statistical significant in percent reporting treatment helped (p value = 1)