Temporomandibular Disorder, Migraine, and Fibromyalgia Linked to Greater Distress

Pankaew Yakkaphan

Credit: ResearchGate

A study found that patients with comorbid TMD, migraines, and fibromyalgia suffer the most severe pain and psychological distress, as well as impaired quality of life, compared to those with fewer or no comorbidities.¹

“These findings underscore the importance of a comprehensive and integrated approach to the assessment and management of TMD patients, considering the presence of comorbidities and addressing both physical and psychological aspects of the condition,” wrote the investigators, led by Pankaew Yakkaphan, from the Faculty of Dentistry, Oral & Craniofacial Science, King's College London.

Previous research found 3 out of 4 patients with fibromyalgia have comorbid TMD, and 55% of individuals with TMD have migraines.² Despite the common comorbidities, the nature of TMD’s relationship with migraines and fibromyalgia was unclear.¹

Investigators aimed to assess the impact of migraines and fibromyalgia in patients with TMD on anxiety, depression, and quality of life. They also sought to investigate how anxiety, depression, and quality of life related to the number of comorbidities to better understand their interactions.

The team conducted a retrospective study of 409 adult patients with TMD, using data from January 2016 to December 2022. Most of the sample were women (79%), and the mean age was 44.43 years. Participants were categorized into 4 groups: without a comorbidity (only TMD) (63.6%; n = 260), comorbid migraine (21.8%; n = 89), comorbid fibromyalgia (3.2%; n = 13), and comorbid migraine and fibromyalgia (3.2%; n = 13).

Compared to participants with only TMD, participants with comorbid migraines reported longer pain duration, greater pain scores, and greater pain interference. Similarly, those with comorbid fibromyalgia have greater pain intensity than patients with only TMD. The groups with comorbid migraines and comorbid fibromyalgia had greater levels of anxiety, depression, and health impairment compared with patients who only had TMD.

“When comparing TMD patients with migraine to those with fibromyalgia, the different type of comorbidity did not differently impact on pain outcomes, anxiety, and depression, but it affected on the quality of life and overall general health of these individuals,” investigators wrote. “However, it is important to note that the number of subjects with TMD + FM in our study was relatively small.”

Patients with all 3 conditions—TMD, migraines, and fibromyalgia—experienced the longest pain duration at 91 months, compared to 43, 54, and 51 months for those with no comorbidity (P < .001), comorbid migraine, and comorbid fibromyalgia (P = .034), respectively. Investigators observed a positive association between pain duration and the number of comorbidities (B = 0.00, 95% CI [0.20, 0.38], β = 0.17, P = .004).

As for pain intensity, patients with all 3 conditions demonstrated the greatest mean scores for the most intense pain (7.5), average pain (6.0), and the least severe pain (5.50) compared to patients with only TMD.

The assessment of pain disability using the Grade Chronic Pain Scale showed a significant difference among the 4 groups (P < .001), with patients who had all 3 conditions experiencing the greatest disability and severe functional limitation at 63%, followed by patients with 1 comorbidity (42%). Patients with only TMD demonstrated a low intensity of pain and low disability levels.

The prevalence of mild to severe anxiety was the greatest for patients with comorbid fibromyalgia (88.9%), followed by all 3 conditions (58.3%), comorbid migraines (40.6%), and only TMD (23%). Patients with either migraines or fibromyalgia reported significantly greater mean anxiety scores than patients with TMD alone (P < .001 and P = .003, respectively).

Likewise, patients with comorbid fibromyalgia had the greatest depression prevalence, but patients with all 3 conditions had the greatest depression scores of 9.08. This score was significantly greater than those with only TMD (P = .002).

The results demonstrated positive associations between pain outcomes, psychological measures, and pain’s impact on quality of life. The study also found a negative association between overall health states and the number of comorbidities ((B = −0.01, 95% CI [−0.01, −0.00], β = −0.32, P < .001).

“The results of the study shed light on [the] significant impact of migraine and fibromyalgia on various aspects of TMD, including pain duration, intensity, interference, psychological well-being, quality of life, and overall health status,” investigators wrote. “Additional research is needed to clarify the underlying mechanisms and design focused interventions to meet the intricate needs of individuals with TMD and other pain-related comorbidities. Prospective studies are essential to investigate causal relationships and interventions aimed at alleviating the compounded impact of TMD with comorbid conditions.”

References

1. ^{Yakkaphan P, Lambru G, Renton T. Impact of migraine and fibromyalgia on temporomandibular disorder: A retrospective study on pain, psychological factors and quality of life. J Oral Rehabil. Published online July 4, 2024. doi:10.1111/joor.13789}
2. ^{Pine, L. 3 Out of 4 Patients with Fibromyalgia Have Comorbid Temporomandibular Disorders. HCPLive. December 4, 2023. https://www.hcplive.com/view/3-out-of-4-patients-with-fibromyalgia-have-comorbid-temporomandibular-disorders. Accessed August 1, 2024.}