I would like to comment on the article "Myofascial Face Pain: Clinical Characteristics of Those With Regional vs. Widespread Pain" (February JADA).
In the study, the authors noted that the diagnosis of myofascial face pain, or MFP, was based on criteria of the International Association for the Study of Pain: "Tenderness in one or more muscles of mastication together with a clicking or popping noise in the temporomandibular joint and/or limitation of mandibular range."
Notably missing from their definition is the presence of pain. Unfortunately, the aforementioned array is merely indicative of generic TMD/orofacial dysfunction, and certainly not MFP, as identified by Travell.
According to Travell, indisputably an acknowledged authority on the subject, myofascial pain is uniquely characterized from other types of muscle pain by the presence of trigger points. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, identified by pain or compression, which can elicit referred pain (often at a distance from the trigger point) and autonomic phenomena.
The authors’ definition fails to distinguish MFP from myositis, muscle spasm, muscle contracture, muscle splinting, all types of internal derangements, osteoarthritis and rheumatoid arthritis, among others.
Travell states that a definition such as this, or the research diagnostic criteria one mentioned in the article invites the use of MFP "as a catch-all diagnosis for any patient with facial pain of unknown origin."
The reality is that the article merely explores whether TMJ/orofacial pain accompanied by a history of widespread pain is more debilitating and has a higher rate of depression than TMJ/orofacial pain alone. Do we really need to spend NIDCR grant money to answer such a self-evident question?
The JADA article closes by recommending that patients seeking treatment for a "TMJ/orofascial" problem be assessed for fibromyalgia. Isn’t it common knowledge that any doctor addressing facial pain and neglecting to take a complete health history would be practicing beneath a reasonable [standard] of care?
This article uncovers nothing new. The definition of MFP is misleading double-talk. The information put forth borders on trivia and reveals nothing that isn’t commonly known by anyone with a modicum of common sense.
