title: Parasympathetic reactivity in fibromyalgia and temporomandibular disorder: associations with sleep problems, symptom severity, and functional impairment.
abstract: Despite evidence of autonomic disturbances in chronic multisymptom illnesses such as temporomandibular disorder (TMD) and fibromyalgia, additional work is needed to characterize the role of parasympathetic reactivity in these disorders. Given the high levels of comorbidity with psychiatric disorders characterized by stronger parasympathetic decline than controls in safe contexts (leading to higher arousal), it was hypothesized that individuals with TMD and fibromyalgia would respond similarly. In this preliminary investigation, 43 women with TMD (n = 17), TMD + fibromyalgia (n = 11), or neither (controls; n = 15) completed a baseline assessment of respiratory sinus arrhythmia (a measure of parasympathetic activity) followed by ongoing parasympathetic assessment during a questionnaire period. As predicted, patients showed greater parasympathetic decline during psychosocial assessment, suggesting an autonomic stance that supports defensive rather than engagement behaviors. Individual differences in parasympathetic reduction during the questionnaire period were related to a variety of physical and psychosocial variables. Although this study has a number of key limitations, including a convenience sampling approach and small group sizes, if replicated in larger samples, the findings would have important implications for the treatment of patients with these disorders.
  
  
  CONCLUSIONS
  Compared to controls, individuals with TMD or TMD and fibromyalgia demonstrated greater parasympathetic decline during psychosocial assessment, and individual differences in parasympathetic decline predicted negative patient outcomes. Such parasympathetic decline may demonstrate a tendency to readily perceive danger in safe environments.
authors.affiliation: Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: t.eisenlohr.moul@gmail.com.
authors.forename: Tory A
authors.initials: TA
authors.lastname: Eisenlohr-Moul
authors.affiliation: Division of Rheumatology and Women's Health, College of Medicine, University of Kentucky, Lexington, Kentucky.
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Crofford
authors.affiliation: Division of Rheumatology and Women's Health, College of Medicine, University of Kentucky, Lexington, Kentucky.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Howard
authors.affiliation: Division of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, Kentucky.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Yepes
authors.affiliation: Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Carlson
authors.affiliation: Division of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, Kentucky.
authors.forename: Reny
authors.initials: R
authors.lastname: de Leeuw
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D006339:Heart Rate; D006801:Humans; D007206:Individuality; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D010147:Pain Measurement; D010275:Parasympathetic Nervous System / Q000503:physiopathology*; D065809:Respiratory Sinus Arrhythmia; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult
keywords: Autonomic reactivity; chronic pain; fibromyalgia; polyvagal theory; respiratory sinus arrhythmia; temporomandibular disorder