Autonomic function, CFS and temporomandibular disorder

[MeSci]

I couldn't find this here, to my surprise.

Lucy J. Robinsonab, Justin Durhamc, Laura L. MacLachland & Julia L. Newtonde

Published online: 05 Oct 2015

Abstract

Background: Chronic fatigue syndrome (CFS) is heterogeneous in nature, yet no clear subclassifications currently exist. There is evidence of dysautonomia in almost 90% of patients and CFS is often co-morbid with conditions associated with autonomic nervous system (ANS) dysfunction, such as temporomandibular disorders (TMD). The present study examined the point prevalence of TMD in a sample of people with CFS and explored whether co-morbidity between the conditions is associated with greater ANS dysfunction than CFS alone.

Method: Fifty-one patients and 10 controls underwent screening for TMD. They completed a self-report measure of ANS function (COMPASS-31) and objective assessment of heart rate variability during rest and standing (derived using spectral analysis). Frequency densities in the high-frequency (HF) and low-frequency (LF) band were calculated.

Results: Patients with CFS were divided into those who screened positive for TMD (n = 16, 31%; CFS + TMD) and those who did not (n  = 35, 69%; CFS − TMD). Both CFS groups had significantly higher self-rated ANS dysfunction than controls. CFS + TMD scored higher than CFS − TMD on the orthostatic and vasomotor subscales. The CFS + TMD group had significantly higher HF and significantly lower LF at rest than the other two groups. In discriminant function analysis, self-report orthostatic intolerance and HF units correctly classified 75% of participants.

Conclusions: Almost one-third of CFS patients screened positive for TMD and this was associated with greater evidence of parasympathetic dysfunction. The presence of TMD shows potential as an effective screen for patients with CFS showing an autonomic profile and could help identify subgroups to target for treatment.

http://www.tandfonline.com/doi/full/10.1080/21641846.2015.1091152

 

[Scarecrow]

I've never see it reported before that TMD is associated with ANS dysfunction.

@MeSci do you have access to the full text? Any idea what the citation for that would be?

 

[eafw]

Interesting, I have had TMJ a long while, though it does come and go a bit. Is the speculation that the jaw muscles don't switch off properly in people with parasympathetic/autonomic problems OR the other way round, that TMJ exacerbates autonomic dysregulation ?

 

[Research 1st]

TMD isn't associated to ANS dysfunction in terms of pathology of course. TMD is, however, common in ME 'CFS' and ME sufferers have POTS.

To many, it's now patently obvious, it's the pathogens we have that damage our CNS, leading to ANS dysfunction and ME via chronic inflammation/autoimmunity.

It should also be noted that Lyme, is associated to all 3: ANS Dysfunction, ME 'CFS' & TMJ.

 

[Jonathan Edwards]

I've never see it reported before that TMD is associated with ANS dysfunction.

@MeSci do you have access to the full text? Any idea what the citation for that would be?

I cannot work out why there should be a relation, or why anyone should look for it, but maybe I am missing something.

 

[Strawberry]

I cannot work out why there should be a relation, or why anyone should look for it, but maybe I am missing something.

I definitely agree, but want to see the full paper. I have had severe TMJD for nearly 35 years (age 15) while my fatigue/stamina/allergy issues started in early to mid 20s, and chronic sore throat late 20s. Now partially disabling fatigue in the last 3 years. I fell and split my chin open two times as a child, and TMJ set in after having my wisdom teeth removed at 15. I'm not quite understanding how that could have caused my CFS. To me it would be unrelated.

Yet I am curious as all get out!

 

[Mark]

I was recently tested for TMD when being fitted with a maxillofacial device for my sleep apnea. The specialists said that the shape of my jaw - typical of the people they treat - could explain why the classical treatment for the sleep apnea (CPAP mask) hadn't been effective, and the maxillofacial device has indeed been much more effective and his improved the quality of my sleep significantly. I have had minor problems with my jaw clicking in the past, but they said I didn't have TMD. Nevertheless, it seems interesting that there may be this association between TMD (and perhaps in my case a somewhat TMD-like jaw) and atypical sleep apnea...perhaps there is a clue here to a subset of the CFS population (under broad CFS definitions) where TMD and resulting sleep problems may be particularly significant. N=1 but I thought I should post my experience in case it offers any clues as to the connections this research may be pointing at.

 

[Scarecrow]

I cannot work out why there should be a relation, or why anyone should look for it, but maybe I am missing something.

TMJ is listed as one of the co-morbid entities in the CCC.

I can tick off a few of the following and all of the ones that apply to me don't require too much of a stretch to connect them to ANS dysfunction but TMD/TMJ has always stood out as being different. I don't doubt that there is an association between ME and TMD but what is the basis of it? I never imagined that the connection would be ANS dysfunction but the abstract implies more than simple correlation.

Co-Morbid Entities: Fibromyalgia Syndrome (FMS), Myofascial Pain

Syndrome (MPS), Temporomandibular Joint Syndrome (TMJ), Irritable
Bowel Syndrome (IBS), Interstitial Cystitis, Irritable Bladder
Syndrome, Raynauds Phenomenon, Prolapsed Mitral Valve, Depression,
Migraine, Allergies, Multiple Chemical Sensitivities (MCS),
Hashimotos thyroiditis, Sicca Syndrome, etc. Such co-morbid entities

may occur in the setting of ME/CFS. Others such as IBS may precede
the development of ME/CFS by many years, but then become
associated with it. The same holds true for migraines and depression.
Their association is thus looser than between the symptoms within the
syndrome. ME/CFS and FMS often closely connect and should be
considered to be overlap syndromes.

Is eafw's first suggestion plausible? It can't be the whole story. My jaw is only sporadically painful but I can never open my mouth smoothly - it always partially dislocates. I can't see it as a purely muscular problem.

Interesting, I have had TMJ a long while, though it does come and go a bit. Is the speculation that the jaw muscles don't switch off properly in people with parasympathetic/autonomic problems OR the other way round, that TMJ exacerbates autonomic dysregulation ?

 

[Strawberry]

Actually, just to update my post, I would think the only connection would be inflammation in the joints. If there is inflammation of the joints, TMJD issues should almost be expected. But I fully do not agree that my TMJD is linked to or caused my CFS. Nor do I think it would be effective for screening for CFS.

But still wanting to see the full article...

 

[Hip]

Substance P might be the connection between a temporomandibular disorder (TMD) and the autonomic nervous system.

I believe the neurotransmitter substance P is elevated in TMD (though at the moment I cannot find a reference for this, except here where it says: "serum levels of substance P levels are known to increase by over tenfold with bite dysfunction").

Now this rat study found that on injection of substance P, both cardiac sympathetic nervous system activity and parasympathetic nervous system activity increase.

 

[Marco]

This study suggests sympathetic over-activation in TMD related to dysregulated pain processing :

http://www.medscape.com/viewarticle/753683

While this small study suggests an impaired sympathetic response to stress (teeth clenching) :

http://www.tmj.org/site/page?pageId=166

I've had teeth grinding and clicking jaws for donkey's years - but no pain to speak of.

 

[MeSci]

I've never see it reported before that TMD is associated with ANS dysfunction.

@MeSci do you have access to the full text? Any idea what the citation for that would be?

Sorry - forgot to include the title - it's 'Autonomic function in chronic fatigue syndrome with and without painful temporomandibular disorder.' (I found it by clicking on Julia's name.)

I don't know if the full text is freely available - you could try a search using some of the text in double quotes.

 

[MeSci]

Another article by the same authors:
A systematic review of the comorbidity between Temporomandibular Disorders and Chronic Fatigue Syndrome

Summary
The most common cause of chronic oro-facial pain is a group of disorders collectively termed temporomandibular disorders (TMDs). Chronic painful TMD is thought to be a ‘central sensitivity syndrome’ related to hypersensitivity of the nervous system, but the cause is unknown. A similar understanding is proposed for other unexplained conditions, including chronic fatigue syndrome (CFS). Exploring the comorbidity of the two conditions is a valuable first step in identifying potential common aetiological mechanisms or treatment targets.

Method
Systematic literature review. Studies were included if they recruited community or control samples and identified how many reported having both TMD and CFS, or if they recruited a sample of patients with either TMD or CFS and measured the presence of the other condition.

Results
Six papers met inclusion criteria. In studies of patients with CFS (n = 3), 21–32% reported having TMD. In a sample of people with CFS and fibromyalgia, 50% reported having TMD. Studies in people with TMD (n = 3) reported 0–43% having CFS. Studies in samples recruited from oro-facial pain clinics (n = 2) reported a lower comorbidity with CFS (0–10%) than a study that recruited individuals from a TMD self-help organisation (43%).

Conclusion

The review highlights the limited standard of evidence addressing the comorbidity between oro-facial pain and CFS. There is a valuable signal that the potential overlap in these two conditions could be high; however, studies employing more rigorous methodology including standardised clinical assessments rather than self-report of prior diagnosis are needed.

Full text is behind a paywall, but this page has further info about the study (I think).

 

[Strawberry]

Once again, hoping somebody has access to the full paper? Or the one above? I am not understanding (as stated earlier) the link. CFS sufferers have inflammation. The temporal mandibular joint is a small and complex joint, if there is any inflammation in the system this joint will understandably have issues.

IMHO this is like saying "people with caries/cavities seem to all have teeth."

Can anyone access the paper(s)?

 

[sillysocks84]

This is weird. I noticed my left jaw joint started clicking and popping when I had my onset. Some days it doesn't click. The days it clicks my whole illness is more symptomatic. Still I don't understand why.