The February JADA cover story ("Myofascial Face Pain: Clinical Characteristics of Those With Regional vs. Widespread Pain" by Karen G. Raphael, Ph.D., and colleagues) did more, I fear, to confuse people than to clarify facts.
How exactly do the authors define myofascial face pain? How does it differ from myofascial pain of the head and neck? It’s hard for me to believe that professionals today would narrow myofascial pain simply to "the face," and then compare these patients with those with fibromyalgia, or FMS.
If one understands myofascial pain, "myo" meaning muscle, and "fascia" defined as a type of connective tissue involved with the muscles of the entire body, then at the very least you need to look at myofascial pain of the head and neck. How can one possibly isolate face pain from other interacting muscles?
Insurance companies require ICD diagnostic codes for temporomandibular disorders, or TMD. Most (if not all) patients with TMD have at least two diagnoses, each with a code number. They are Internal Derangement and Myofascial Pain of Head and Neck. I am unaware of an insurance company TMD diagnostic code number for Myofascial Face Pain.
The more I tried to make sense of the article, the more confusing it became. So I mailed a copy of the article to Devin Starlanyl, M.D., author of "Fibromyalgia and Chronic Myofascial Pain Syndrome: A Survival Manual," for her opinion. We agreed that the criteria for this "research" were vague and the results meaningless. The authors failed to mention in their references Drs. Travell and Simons, world renowned for their book, "Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual." They never mentioned myofascial pain due to trigger points. They never acknowledged that chronic myofascial pain could be bodywide, without fibromyalgia being involved. And the importance of perpetuating factors was not to be found. We concluded that [the article] added little to the literature, only more confusion. Enough said.
Dr. Starlanyl has an excellent Web site at "www.sover.net/~devstar". I recommend it for professionals who wish to learn how to manage patients suffering from TMD, fibromyalgia, chronic myofascial pain syndrome and related disorders.
For those who would like more information on FMS, I also highly recommend the article by Dr. Harold C. Slavkin, "Chronic Disabling Diseases and Disorders: The Challenges of Fibromyalgia" (November 1997 JADA). He points out that only a small percentage of patients with TMD (18.4 percent) also have FMS, but that most individuals with FMS (75 percent) also have myofascial TMD.
When are the dental and medical professions going to wake up and provide accurate information on TMD? If you try the ADA, American Medical Association, National Institutes of Health or Mayo Clinic Web sites you will find ... nothing! What has happened? We in the dental profession need to have a clear understanding of chronic myofascial pain, how to diagnose it, treat it and help patients deal with it. The hour is now!
