Abstract
Temporomandibular disorders (TMD) stand as the most common orofacial pain disorders among non-dental pain origin. The study into this condition extends beyond its immediate boundaries, given its frequent co-occurrence with various pain disorders. This thesis explores the intricate web of relationships between TMD and comorbidities, with a particular focus on migraine and fibromyalgia (FM). The thesis consists of separate investigations aimed at the understanding of these relationships across multiple dimensions and shedding light on the prevalence of these comorbidities, their profound impact on psychosocial well-being, the influence on endogenous pain modulation (EPM), and the potential impact of migraine treatment on comorbid TMD symptoms.The study of the prevalence of TMD in concomitant migraine revealed that migraine was the most prevalent headache disorder among TMD patients with a prevalence rate of 40%, while FM was present in approximately 32% of individuals with TMD.
In addition to prevalence, TMD patients with comorbid migraine and/or FM had prolonged and more intense pain, heightened anxiety and depression levels, and diminished overall health compared to those with TMD alone. Both migraine and FM had similar effects on pain and psychological symptoms, but TMD patients with FM comorbidity experienced a more substantial impact on their quality of life and greater impairment in general health. Moreover, as the number of comorbidities increased, patients experienced longer pain duration, greater pain interference, heightened pain intensity, increased psychological symptoms, more significant impairment in their quality of life, and worsened overall health. Furthermore, the presence of pain comorbidities appears to hinder the ability to modulate pain beyond the trigeminal nerve region. The attempt to categorize pain patients into pain modulation profiles (PMP) showed promise, with noticeable variations in pain responses among patients. Finally, the observational cohort study indicated a potentially beneficial effect of migraine treatment on TMD symptoms, with 40% of patients with TMD experiencing improvement. Moreover, there was a trend indicating a correlation between onset, temporal relationship and response to migraine treatment.
In conclusion, this thesis encompasses a series of investigations into the impact of migraine and FM on individuals with TMD from various perspectives. The findings underscore the high occurrence of TMD coexisting with migraine and FM and highlight the substantial impact of comorbidities on both the physical and psychological aspects of TMD patients.
| Date of Award | 1 Sept 2024 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Tara Renton (Supervisor) & Giorgio Lambru (Supervisor) |