TMJ in Fibromyalgia and Chronic Fatigue Syndrome

Written by Adrienne Dellwo, About.com Guide, for About.com

(About.com) - Temporomandibular joint disorder (TMJ) causes jaw pain, and it's more common in people with fibromyalgia (FMS) and chronic fatigue syndrome (CFS or ME/CFS) than it is in the general population.

More than 10 million people in the United States are believed to be affected by the jaw pain TMJ, and the disorder is more common in women than in men.

What is TMJ Disorder?

The temporomandibular joints connect your jaw to your skull. They're stabilized by muscles and ligaments that open and close your mouth. Pain or tenderness in or around the joints is referred to as a TMJ disorder.

The causes of TMJ disorders still aren't well-known, but most experts agree that jaw trauma can lead to it. Other conditions associated with TMJ include:

• Anxiety
• Stress
• Rheumatoid arthritis

The pain of TMJ can range from mild to severe and treatment generally depends on the severity.

Why Do Fibromyalgia, Chronic Fatigue Syndrome and TMJ Disorder Go Together?

We don't know yet why people with FMS and ME/CFS appear to be more prone to TMJ. When TMJ occurs first, it's possible that the pain of TMJ could contribute to the development of central sensitization, which is believed to be a key component of FMS and ME/CFS. When FMS or ME/CFS happens first, TMJ may be related to lax connective tissues believed to be associated with those conditions.

Since people with FMS and ME/CFS feel pain more acutely than others, they may suffer more from disorders, such as TMJ.

Diagnosing TMJ Disorder

TMJ disorders are most often diagnosed and treated by dentists. There's no single widely accepted test for TMJ. Your dentist may check the jaw for tenderness, popping, clicking and difficulty opening and closing your mouth. Your dentist may also see how your teeth fit together by taking an x-ray and a mold of your mouth.

It's a good idea to ask your regular doctor to rule out other causes of facial pain, such as sinus headaches or earaches. Also, if you have myofascial pain syndrome (which is common in people with FMS), trigger points on the sternocleidomastoid muscles in the front of the neck can cause jaw pain. It's unknown whether these kinds of trigger points actually cause TMJ or just cause similar symptoms.

Symptoms of TMJ Disorder

TMJ symptoms, other than headaches, are quite distinct from symptoms of FMS and ME/CFS. TMJ symptoms include:

• Jaw pain
• Discomfort or difficulty chewing
• Painful clicking in the jaw
• Difficulty opening or closing the mouth
• Headaches
• Locking jaw
• Teeth that don't come together properly

Treating TMJ Disorder

In some cases, TMJ symptoms go away on their own. If you have persistent symptoms, your doctor may recommend either conservative treatments or a more aggressive approach.

Conservative TMJ treatments include:

• Stress reduction
• No gum chewing
• Avoiding wide yawning
• Ice packs
• Anti-inflammatory drugs, such as Advil (naproxen) and Motrin (ibuprofen).

More aggressive treatments include:

• Orthodontics
• Surgery

These aggressive treatments are controversial, so you may want to get a second opinion before considering them.

TMJ Treatment vs. Fibromyalgia/Chronic Fatigue Syndrome Treatment

TMJ treatments don't generally interfere with FMS or ME/CFS treatments. Ice packs, however, may be difficult for you to tolerate because of the temperature sensitivity common with FMS or ME/CFS. Also, surgery may be less attractive, because it can exacerbate FMS and ME/CFS symptoms, making recovery more difficult. Also, some experts believe that many people with ME/CFS are sensitive to certain types of anesthesia, although this has not been proven in clinical studies.

Any time you're taking medication for more than one condition, you should talk with your doctor and pharmacist about possible drug interactions.

Living With TMJ Disorder and Fibromyalgia/Chronic Fatigue Syndrome

The pain of TMJ can make your FMS or ME/CFS more difficult to manage, but treating your TMJ can keep it from worsening other symptoms.

Scientists from the National Institutes of Health are conducting a wide range of studies to better understand the pain process, including the facial pain of TMJ and what it has in common with disorders involving widespread muscle pain. This research could help us better understand TMJ and its relationship to FMS and ME/CFS, leading to better treatment as well.

_Sources:

American Dental Association. All rights reserved. "Chronic Fatigue Syndrome"

British Journal of Anaesthesia. All rights reserved. "Anaesthesia for patients with idiopathic environmental intolerance and chronic fatigue syndrome."

Lapp, Charles W., MD, Hunter-Hopkins Center. All rights reserved. "Recommendations for Persons with Chronic Fatigue Syndrome (or Fibromyalgia) Who are Anticipating Surgery"

National Institute of Dental and Craniofascial Research. "TMJ Disorders"