This document summarizes two articles about fibromyalgia. The first article conducted a systematic review of structural and functional brain MRI studies of fibromyalgia patients. It found gray matter atrophy in areas like the anterior cingulate cortex and increased neuronal activity in response to pressure. The second article discusses how dental professionals can help diagnose and manage fibromyalgia patients based on criteria like tender points and common comorbidities like temporomandibular disorders. Dentists should be aware that fibromyalgia often presents as TMD and adjust treatments accordingly.
This document summarizes two articles about fibromyalgia. The first article conducted a systematic review of structural and functional brain MRI studies of fibromyalgia patients. It found gray matter atrophy in areas like the anterior cingulate cortex and increased neuronal activity in response to pressure. The second article discusses how dental professionals can help diagnose and manage fibromyalgia patients based on criteria like tender points and common comorbidities like temporomandibular disorders. Dentists should be aware that fibromyalgia often presents as TMD and adjust treatments accordingly.
This document summarizes two articles about fibromyalgia. The first article conducted a systematic review of structural and functional brain MRI studies of fibromyalgia patients. It found gray matter atrophy in areas like the anterior cingulate cortex and increased neuronal activity in response to pressure. The second article discusses how dental professionals can help diagnose and manage fibromyalgia patients based on criteria like tender points and common comorbidities like temporomandibular disorders. Dentists should be aware that fibromyalgia often presents as TMD and adjust treatments accordingly.
functional brain MRI: A Summary Rehabilitation sciences and physiotherapy researchers at several Belgium universities worked together to explore the effects of pain sensitization of musculoskeletal disorders like fibromyalgia (FM) on both the central brains structure and degree of functionality. The disease is marked by both amplified pain sensitization (hyperalgesia) and translation of non-painful stimulation into central nervous system (CNS) pain sensitization (allodynia). FMs CNS hyperexcitability prompted the increased use of non-invasive imaging procedures to map changes to the brain and elsewhere in response to the diseases characteristic chronic pain effect. A non-invasive neuroimaging method includes voxel- based morphometry, which changes in brain volume by using statistical tools for comparison. Other techniques like functional magnetic resonance imaging (fMRI) and resting-state functional magnetic resonance imaging (rs-fMRI) have also quantified changes to the brain for such chronic pain patients. Pain in Motion research group, University of Antwerp researchers, and Ghent university parsed through articles pulled from medical electronic databases: PubMed and Web of Science. NIHs controlled medical subject headings and evidence-based models guided the use of specific search terms like FM for patient population; structural and functional MRI for diagnostic instrument; central sensitization (among other variants) for outcome measures. Two physiotherapists led the article review. Moreover, the Dutch Cochrane Centres online checklist for research quality control was implemented to evaluate the studies chance for bias in areas like patient group description, control group description, selection bias, exposure, confounders, etc. The search query yielded a narrowed dataset of 52 references and nine articles of which only 22 studies were used for final qualitative analysis, which had full agreement by both the article reviewers. Evidence tables were produced to compare each studies patient group composition, control group composition, main findings, and ancillary remarks. Unfortunately, some of the studies lacked pertinent information relating to age and gender of the patient groups. In terms of their findings, some studies found no difference in global gray matter density between patient and control groups; others established significant brain volume and cortical thickness differences for fibromyalgia patients experiencing prolonged chronic pain episodes. According to the qualitative review, unchanged global gray matter volume; gray matter atrophy in the anterior cingulate cortex, insula, thalamus, pons, left precuneus, etc.; higher neuronal activity and more pain upon equal pressure stimulus; extended pain perception upon nociceptive stimulation by injection; and temporal brain activation in FM patients. Further evaluation is needed to examine larger populations of as well as mechanisms behind the CS pain processing activity of FM patients. Fibromyalgia: an update for oral health care providers? A Summary Fibromyalgia (FM) patients experience chronic pain from a disorder once classified as a musculoskeletal disease. As part of a large family of pain disorders, FM can present symptoms globally in patients, and, as a result, dentists and other oral health care providers can play a role in recognizing and diagnosing FM in their patients suffering from chronic care. The potential for increased diagnostic help by dental professionals may prove to be a healthcare management boon as fibromyalgia affects up to 5% of the U.S. population, targeting females nine times higher than males. Dental professionals ought to be versed in the FM classification criteria outlined by the American College of Rheumatology (ACR). FM patients typically present with pain for more than 3 months globally around their body in areas defined, but not limited to, diagnostic tender points: medial fat pad of knee, muscle areas posterior to greater trochanter, upper border of trapezius, muscle insertion area into occiput, etc. Specifically, if upon external pressure or palpation, the patient experiences tenderness or signs of allodynia, stipulations defined by ACR may be fulfilled in diagnosing FM. Unfortunately, FMs etiology is not known. However, recent research has shown FM patients presenting with neuroendocrine dysfunction in areas like the sympathoadrenal system and the HPA- axis, as well as serotonin, norepinephrine, and adenosine triphosphate level abnormalities. Furthermore, nearly 33% of FM patients exhibited lowered blood pressure and increased syncope episodes; moreover, other FM patients presented with nighttime sympathetic tone, which may be a response to decreased inhibitory neuronal pathways. Also, FM sera exhibit abnormal quantities of growth hormone, tryptophan, serotonin, substance P, cytokine, interleukin-6, etc. FM patients characterize their symptoms as diffuse, deep, throbbing, or stabbing; other FM patients may experience sleep disturbances, dizziness, fatigue, IBS, dysmenorrhea, stiffness, fever, swollen glands, dry eyes, non-restorative sleep, chest pain mimicking angina pectoris, etc. Comorbidities include IBS, chronic fatigue syndrome, temporomandibular disorder, chronic headaches, lower back pain, and interstitial cystitis. Upon assessing and c confirming these clinical signs, dental professionals need to place a referral to a rheumatologist or a rehab physician for further management and treatment. In terms of non-medical areas affected or related to the disease, dentists should also be aware that many FM patients have a lower socioeconomic status and may hold stigma upon disease diagnosis. For treatment options, tricyclic antidepressants, selective serotonin reuptake inhibitors like fluoxetine; serotonin-norepinephrine reuptake inhibitors like duloxetine; muscle relaxants like cyclobenzaprine; anticonvulsants like pregabalin; analgesics like tramadol; cognitive behavior therapy; herbal supplements like ginseng and melatonin; and transcranial direct current stimulation may be prescribed for chronic care management. Dentists need to be aware that FM primarily presents as the temporomandibular disorders (TMD); headaches; and oral complaints. TMDs (excluding internal temporomandibular joint derangements) like masticatory myalgia and joint pain may be signs of FM. Distinguishing between trauma-related TMD and FM-related TMD must be practiced by oral health care professionals. Treatment options for TMD in FM patients need to be conservative as little research has been conducted in this area of chronic pain care. Moreover, dentists should be aware of nonspecific headaches like migraines or tension- type headaches. Onset of headaches, duration of headaches, consequential analgesic use, etc. need to be explored with the patients. Furthermore, other oral complaints by patients potentially with FM include xerostomia (dry mouth); glossodynia (oral burning); and dysgeusia (taste distortion). A table of dental considerations outlines points dentists need to cover in visits like preoperative considerations such as medical history, oral complaint history, and orofacial pain and headache complaints. Intraoperative considerations include TMD presentation. Postoperative points of considerations include persistence of jaw pain, in which case opioid analgesics, macrolide antibiotics, and NSAIDs may need to be prescribed depending on the primary line of medication (e.g. TCAs or SSRIs).