title: The relationship between temporomandibular disorders and stress-associated syndromes.
abstract: OBJECTIVE
  The purpose of this study was to determine the comorbidity of temporomandibular disorders and other stress-associated conditions in patients with chronic fatigue syndrome and fibromyalgia.
  
  
  METHODS
  Of 92 patients who fulfilled the criteria for chronic fatigue syndrome or fibromyalgia (or both), 39 (42%) reported a prior diagnosis of temporomandibular disorder. Further questionnaires were sent to the members of this group, and 30 patients responded.
  
  
  RESULTS
  Of the original 92 patients, of whom 42% reported temporomandibular disorders, 46% had histories of irritable bowel syndrome, 42% of premenstrual syndrome, and 19% of interstitial cystitis. Of the patients with temporomandibular disorders, the great majority reported an onset of generalized symptoms before the onset of facial pain. Despite this, 75% had been treated exclusively for temporomandibular disorders, usually with bite splints.
  
  
  CONCLUSIONS
  Patients appearing for treatment with chronic facial pain show a high comorbidity with other stress-associated syndromes. The clinical overlap between these conditions may reflect a shared underlying pathophysiologic basis involving dysregulation of the hypothalamic-pituitary-adrenal stress hormone axis in predisposed individuals. A multidisciplinary clinical approach to temporomandibular disorders would improve diagnosis and treatment outcomes for this group of patients.
authors.affiliation: Department of Psychiatry and School of Dentistry, University of Michigan, Ann Arbor 48109-0840, USA.
authors.forename: A
authors.initials: A
authors.lastname: Korszun
authors.forename: E
authors.initials: E
authors.lastname: Papadopoulos
authors.forename: M
authors.initials: M
authors.lastname: Demitrack
authors.forename: C
authors.initials: C
authors.lastname: Engleberg
authors.forename: L
authors.initials: L
authors.lastname: Crofford
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005157:Facial Pain / Q000209:etiology / Q000503:physiopathology; D015673:Fatigue Syndrome, Chronic / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005356:Fibromyalgia / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011602:Psychophysiologic Disorders / Q000209:etiology / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications* / Q000503:physiopathology; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000209:etiology* / Q000503:physiopathology