Fibromyalgia in patients with chronic CCD and CMD - A retrospective study of 555 patients

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.

Keywords:

• Fibromyalgia
• chronic pain
• cranio mandibular dysfunction
• cranio cervical dysfunction
• functional spinal disorders
• AWMF
• interdisciplinary myozentric splint therapy
• manual therapy
• atlas pulse therapy after Arlen

Abbreviations:

• ACR: American College of Rheumatology
• AWMF: Association of the Scientific Medical Societies in Germany
• CCD: Craniocervical dysfunction
• CMD: Craniomandibular dysfunction
• CWP: Chronic widespread pain
• EMG: Electromyography
• ENT: Ears, nose and throat
• FMS: Fibromyalgia syndrome
• ICCMO: International College of Cranio-Mandibular Orthopedics
• TMJ: Temporomandibular joint
• WPI: Widespread pain index