Myofascial Face Pain and Fibromyalgia

Previous studies have reported that patients suffering myofascial face pain (MFP) are likely to report high rates of widespread pain associated with fibromyalgia (FM). This recent study aimed to determine differences in clinical characteristics between patients with only MFP and patients suffering both MFP and FM.

Using the records of a clinician specializing in treatment of chronic facial pain, the researchers identified 162 female patients whose records showed they met diagnostic criteria for MFP. An average of 7 years had elapsed between the time of physical examination of the patients and the time of this study. Researchers conducted structured telephone interviews to determine the patients' health and psychiatric histories.

Of the 162 patients, 38 (23.5%) reported a history of FM. At the time of physical examination, both the 38 that had reported a history of FM and those that did not report FM had exhibited similar signs and symptoms of MFP. Those with both MFP and FM were:

• less likely to recover from MFP. Only 2.7% of patients with both FM and MFP were free of facial pain at the end of the study, as opposed to 25% of the non-FM patients.
• reported more symptoms of MFP that were more severe and were more likely to interfere in social and occupational function.
• more likely to have had a history of major depression and somatization of symptoms.

The authors conclude that those patients with both MFP and fibromyalgia are likely to suffer more persistent and debilitating MFP than those that do not have a history of FM. Those with both conditions are also likely to have higher rates of depression and somatization of symptoms.

This study was limited in that it could not address issues of similar or different pathogenesis of FM vs. MFP, nor could it explain the association between them. The study used patients self reports to assess presence of FM, which raises questions as to how the conclusion may have been affected. Nevertheless, the authors assert that their findings are,

"... clinically significant in that they show that the course of, outcome of and disability associated with MFP are influenced by whether MFP is accompanied by symptoms of FM. Thus it is recommended that symptoms of FM be assessed among patients seeking treatment of a regional myofascial problem such as MFP."

Raphael K, Marbach J, Klausner J. Myofascial face pain clinical characteristics of those with regional vs. widespread pain. The Journal of the American Dental Association 2000;131:161-171.