Corsalini Massimo, Daniela Di Venere, Biagio Rapone, Gianluca Stefanachi, Alessandra Laforgia, Francesco Pettini
Dental School - University of Bari, Piazza Giulio Cesare, Bari, Italy.
Open Dent J. 2017 Feb 14;11:91-98. doi: 10.2174/1874210601711010091. eCollection 2017.
The purpose of this study is to highlight the evidence of signs and symptoms of craniomandibular disorders (CMD) in patients suffering from fibromyalgia.
The study has been carried out from May 2011 to May 2015, recruiting a sample of fibromyalgia patients at the Department of Neurophysiopathology at the hospital Policlinico in Bari. Among the 150 examined patients, 60 of them have been diagnosed to suffer from fibromyalgia and 27 accepted to be investigated with a gnathologic examination at the Dental School at the University of Bari.
24 patients (88.9%) were women and 3 (11.1%) men; from 26 to 66 years old (average age, 39). 14 patients (51.9%) were affected by primary fibromyalgia, the remaining 13 (48.1%) by secondary fibromyalgia, mainly associated with hypothyroidism (29.6%). VAS average score was about 8 ± 1.85. The frequency of pain was daily in 15 patients (55.6%); twice a week in 10 patients (37.03%) and a few times a month in 2 patients (7.4%). 11 patients (40.7%) attributed the onset of fibromyalgia to a specific instigating event. In addition, from the gnathologic anamnesis, 11 patients (40,7%) reported a painful symptom in the head-neck region, especially in the frontal region, in the neck, in the masseter muscle and ATM. VAS average score was 3.4 ± 2.8, significantly lower than the one referring to the fibromyalgia pain. The gnathological examination found CMD signs and symptoms in 18 patients (66.7%). Concerning the prevalence of CMD, in type I fibromyalgia, myofascial pain was more frequent (5 patients), whereas in type II fibromyalgia, what was more frequent was a dislocation with reduction (3 patients).
Based on clinic experience, we can affirm that some patients with CMD report pain in other regions. It is difficult to distinguish the CMD forms directly correlated to fibromyalgia from those engendered by parafunctional activities; hence the need is to resolve the fibromyalgia syndrome adopting a multidisciplinary approach.
本研究旨在强调纤维肌痛患者颅下颌关节紊乱症（CMD）的体征和症状证据。
本研究于2011年5月至2015年5月开展，在巴里综合医院神经生理病理学部门招募纤维肌痛患者样本。在150名接受检查的患者中，60人被诊断患有纤维肌痛，其中27人同意在巴里大学牙科学院接受口腔检查。
24名患者（88.9%）为女性，3名（11.1%）为男性；年龄在26至66岁之间（平均年龄39岁）。14名患者（51.9%）患有原发性纤维肌痛，其余13名（48.1%）患有继发性纤维肌痛，主要与甲状腺功能减退有关（29.6%）。视觉模拟评分（VAS）平均得分约为8±1.85。15名患者（55.6%）疼痛频率为每天发作；10名患者（37.03%）为每周发作两次；2名患者（7.4%）为每月发作几次。11名患者（40.7%）将纤维肌痛的发作归因于特定的诱发事件。此外，从口腔病史来看，11名患者（40.7%）报告头颈部区域有疼痛症状，尤其是前额区域、颈部、咬肌和颞下颌关节。VAS平均得分3.4±2.8，显著低于纤维肌痛疼痛的得分。口腔检查发现18名患者（66.7%）有CMD的体征和症状。关于CMD的患病率，在I型纤维肌痛中，肌筋膜疼痛更为常见（5例），而在II型纤维肌痛中，更为常见的是可复性关节脱位（3例）。
根据临床经验，我们可以肯定，一些CMD患者在其他区域也有疼痛。很难直接区分与纤维肌痛直接相关的CMD形式和由副功能活动引起的CMD形式；因此，需要采用多学科方法来解决纤维肌痛综合征。
