Fibromyalgia: practical considerations for oral health care providers

  • Jeon, Younghoon (Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University)
  • Received : 2020.08.29
  • Accepted : 2020.10.05
  • Published : 2020.10.31


Fibromyalgia is a syndrome characterized by chronic pain in the skeletal system accompanied by stiffness, sleep disturbance, fatigue, and psychiatric problems, such as anxiety and depression. Fibromyalgia commonly affects orofacial health, presenting with a variety of oral manifestations, including temporomandibular disorder, xerostomia, glossodynia, and dysgeusia. Therefore, oral healthcare providers need to be aware of this clinical entity to effectively manage oral symptoms and provide proper oral self-care modification and education on the nature of fibromyalgia. This review focuses on the epidemiology, pathophysiology, clinical manifestation, diagnosis, orofacial concerns, and treatment of fibromyalgia.



  1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311: 1547-55.
  2. Morin AK. Fibromyalgia: a review of management options. Formulary 2009; 44: 362-73.
  3. Goldenberg DL, Simms RW, Geiger A, Komaroff AL. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum 1990; 33: 381-7.
  4. Neumeister MW, L Neumeister EL. Fibromyalgia. Clin Plastic Surg 2020; 47: 203-13.
  5. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, et al. Family study of fibromyalgia. Arthritis Rheum 2004; 50: 944-52.
  6. Bergman S, Herrstrom P, Hogstrom K, Petersson IF, Svensson B, Jacobsson LT. Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in Swedish population study. J Rheumatol 2001; 28: 1369-77.
  7. Bergman S. Psychosocial aspects of chronic widespread pain and fibromyalgia. Disabil Rehabil 2005; 27: 675-83.
  8. Buskila D, Neumann L, Press J. Genetic factors in neuromuscular pain. CNS Spectr 2005; 10: 281-4.
  9. Adler GK, Kinsley BT, Hurwitz S, Mossey CJ, Goldenberg DL. Reduced hypothalamic-pituitary and sympathoadrenal responses to hypoglycemia in women with fibromyalgia syndrome. Am J Med 1999; 106: 534-43.
  10. Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology 2000; 25: 1-35.
  11. Russell IJ, Orr MD, Littman B, Vipraio GA, Alboukrek D, Michalek JE, et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 1994; 37: 1593-601.
  12. Pyke T, Osmotherly PG, Baines S. Measuring glutamate levels in the brains of fibromyalgia patients and a potential role for glutamate in the pathophysiology of fibromyalgia symptoms: a systematic review. Clin J Pain 2017; 33: 944-54.
  13. Dhar M. Pathophysiology and clinical spectrum of fibromyalgia: a brief overview for medical communicators. AMWA Journal 2011; 26: 50-4.
  14. Wolfe F, Russell IJ, Vipraio G, Ross K, Anderson J. Serotonin levels, pain threshold, and fibromyalgia symptoms in the general population. J Rheumatol 1997; 24: 555-9.
  15. Ernberg M, Voog U, Alstergren P, Lundeberg T, Kopp S. Plasma and serum serotonin levels and their relationship to orofacial pain and anxiety in fibromyalgia. J Orofac Pain 2000; 14: 37-46.
  16. Cordero MD, Alcocer-Gomez E, Cano-Garcia FJ, de Miguel M, Sanchez-Alcazar JA, Moreno Fernandez AMM. Low levels of serotonin in serum correlates with severity of fibromyalgia. Med Clin (Barc) 2010; 13; 135: 644-6.
  17. Becker S, Schweinhardt P. Dysfunctional neurotransmitter systems in fibromyalgia, their role in central stress circuitry and pharmacological actions on these systems. Pain Res Treat 2012; 2012: 741-6.
  18. Staud R. Autonomic dysfunction in fibromyalgia syndrome: postural orthostatic tachycardia. Curr Rheumatol Rep 2008; 10: 463-6.
  19. Martinez-Lavin M, Hermosillo AG, Rosas M, Soto ME. Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum 1998; 41: 1966-71.<1966::AID-ART11>3.0.CO;2-O
  20. Wood PB, Schweinhardt P, Jaeger E, Dagher A, Hakyemez H, Rabiner EA, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci 2007; 25: 3576-82.
  21. Wood PB. Role of central dopamine in pain and analgesia. Expert Rev Neurother 2008; 8: 781-97.
  22. Kutu FC, Ozdolap S, Sarikaya S. Pro-inflammatory cytokines and oxidized low-density-lipoprotein in patients with fibromyalgia. Arch Rheumatol 2018; 34: 123-9.
  23. Lucas HJ, Brauch CM, Settas L, Theoharides TC. Fibromyalgia--new concepts of pathogenesis and treatment. Int J Immunopathol Pharmacol 2006; 19: 5-10.
  24. Ranzolin A, Duarte AL, Bredemeier M, da Costa Neto CA, Ascoli BM, Wollenhaupt-Aguiar B, et al. Evaluation of cytokines, oxidative stress markers and brain-derived neurotrophic factor in patients with fibromyalgia - a controlled cross-sectional study. Cytokine 2016; 84: 25-8.
  25. La Rubia M, Rus A, Molina F, Del Moral ML. Is fibromyalgia-related oxidative stress implicated in the decline of physical and mental health status? Clin Exp Rheumatol 2013; 31: 121-7.
  26. Jiao J, Vincent A, Cha SS, Luedtke CA, Kim CH, Oh TH. Physical trauma and infection as precipitating factors in patients with fibromyalgia. Am J Phys Med Rehabil 2015; 94: 1075-82.
  27. Adams LM, Turk DC. Psychosocial factors and central sensitivity syndromes. Curr Rheumatol Rev 2015; 11: 96-108.
  28. Hedenberg-Magnusson B, Ernberg M, Kopp S. Symptoms and signs of temporomandibular disorders in patients with fibromyalgia and local myalgia of the temporomandibular system. A comparative study. Acta Odontol Scand 1997; 55: 344-9.
  29. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, et al. The american college of rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010; 62: 600-10.
  30. Buskila D, Cohen H. Comorbidity of fibromyalgia and psychiatric disorders. Curr Pain Headache Rep 2007; 11: 333-8.
  31. Burke NN, Finn DP, Mcguire BE, Roche M. Psychological stress in early life as a predisposing factor for the development of chronic pain: clinical and preclinical evidence and neurobiological mechanisms. J Neurosci Res 2017; 95: 1257-70
  32. Carta MG, Moro MF, Pinna FL, Testa G, Cacace E, Ruggiero V, et al. The impact of fibromyalgia syndrome and the role of comorbidity with mood and post-traumatic stress disorder in worsening the quality of life. Int J Soc Psychiatry 2018; 64: 647-55.
  33. Munguia-Izquierdo D, Legaz-Arrese A. Determinants of sleep quality in middle-aged women with fibromyalgia syndrome. J Sleep Res 2012; 21: 73-9.
  34. Pimentel MJ, Gui MS, de Aquino LM, Rizzatti-Barbosa CM. Features of temporomandibular disorders in fibromyalgia syndrome. Cranio 2013; 31: 40-5.
  35. Hedenberg-Magnusson B, Ernberg M, Kopp S. Presence of orofacial pain and temporomandibular disorder in fibromyalgia. A study by questionnaire. Swed Dent J 1999; 23: 185-92.
  36. Korszun A, Papadopoulos E, Demitrack M, Engleberg C, Crofford L. The relationship between temporomandibular disorders and stress-associated syndromes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1988; 86: 416-20.
  37. Leblebici B, Pektas ZO, Ortancil O, Hurcan EC, Bagis S, Akman MN. Coexistence of fibromyalgia, temporomandibular disorder, and masticatory myofascial pain syndromes. Rheumatol Int 2007; 27: 541-4.
  38. Velly AM, Look JO, Schiffman E, Lenton PA, Kang W, Messner RP, et al. The effect of fibromyalgia and widespread pain on the clinically significant temporomandibular muscle and joint pain disorders--a prospective 18-month cohort study. J Pain 2010; 11: 1155-64.
  39. Walters A, Tolle SL, McCombs GM. Fibromyalgia syndrome: considerations for dental hygienists. J Dent Hyg 2015; 89: 76-85.
  40. Aaron LA, Buchwald D. Chronic diffuse musculoskeletal pain, fibromyalgia and co-morbid unexplained clinical conditions. Best Pract Res Clin Rheumatol 2003; 17: 563-74.
  41. Nguyen TT, Vanichanon P, Bhalang K, Vongthongsri S. Pain duration and intensity are related to coexisting pain and comorbidities present in temporomandibular disorder pain patients. J Oral Facial Pain Headache 2019; 33: 205-12.
  42. Raphael KG, Marbach JJ. Widespread pain and the effectiveness of oral splints in myofascial face pain. J Am Dent Assoc 2001; 132: 305-16.
  43. Adiels AM, Helkimo M, Magnusson T. Tactile stimulation as a complementary treatment of temporomandibular disorders in patients with fibromyalgia syndrome. A pilot study. Swed Dent J 2005; 29: 17-25.
  44. Rhodus NL, Fricton J, Carlson P, Messner R. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol 2003; 30: 1841-45.
  45. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc 2003; 134: 61-9.
  46. Balasubramaniam R, Laudenbach JM, Stoopler ET. Fibromyalgia: an update for oral health care providers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104: 589-602.
  47. Peterson EL. Fibromyalgia: management of a misunderstood disorder. J Am Acad Nurse Pract 2007; 19: 341-8.
  48. Okifuji A, Turk DC, Marcus DA. Comparison of generalized and localized hyperalgesia in patients with recurrent headache and fibromyalgia. Psychosom Med 1999; 61: 771-80.
  49. Marcus DA, Bernstein C, Rudy TE. Fibromyalgia and headache: an epidemiological study supporting migraine as part of the fibromyalgia syndrome. Clin Rheumatol 2005; 24: 595-601.
  50. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Hauser W, Fluss E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318-28.

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