Monthly Archives: November 2012

Fibromyalgia and Temporomandibular Disorders: Are they connected?

People with fibromyalgia are more likely to suffer from jaw disorders than people without the condition, suggests the results of a new study from the University of  São Paulo, Brazil.

Fibromyalgia is known to trigger widespread musculoskeletal pain, but few studies have examined the link between the condition and temporomandibular joint disorders (TMD).

Researchers compared 25 patients with fibromyalgia to 25 healthy participants. Orofacial evaluations and detailed questionnaires showed that fibromyalgia patients had a higher frequency of TMD and pain with jaw movements. They also experienced more pain with head and neck movements, and reported frequent headaches, earaches, and sleep disturbances. Despite these increased symptoms, the fibromyalgia patients did not have any observable differences in dental or intraoral examinations, suggesting that TMD symptoms resulted from a source outside the oral region.

Studies suggest that oral burning sensations in patients with fibromyalgia could be connected to central hyper-excitability, pointed out Eric T. Stoopler in Medscape.

The findings could have important implications for auto-injury patients suffering from widespread chronic pain. It’s possible that a similar mechanism of central hyper-excitability may underlie jaw symptoms in patients with whiplash-associated disorders. Studies show that TMD symptoms are common after whiplash injury but typically have a delayed onset. This delayed development of jaw symptoms could be a sign of sensitization, although more research is needed to investigate this hypothesis.

Whiplash patients can also suffer from widespread chronic pain characteristic of fibromyalgia syndrome.

While the relationship between widespread chronic pain and TMD is still unclear, the study suggests that TMD symptoms may be a potential comorbid condition of fibromyalgia syndrome.


de Silva LA, et al. High prevalence of orofacial complaints in patients with fibromyalgia: a case-control study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 2012; 114(5):e29-34. doi: 10.1016/j.oooo.2012.04.001.

Stoopler ET. Orofacial Pain and Fibromyalgia: What’s the Connection? Medscape Today News. November 16, 2012. Accessed November 28, 2012.

Few Children Wear Bike Helmets, But Brain Injury Education Can Help

Brain injury education can significantly boost helmet use among children, according to a new study from the Georgia Health Sciences University.

Only 1 in 4 children wear a helmet while riding their bikes, and that number is even lower among teens, according to the Centers for Disease Control and Prevention. Meanwhile brain injury is the leading cause of disability and death in bicycle accidents.

Another recent study of pediatric brain injuries found that wearing a helmet can reduce the acceleration of the skull in accident by 87%.

This latest research from Georgia Health Sciences University suggests that safety education could play a role in preventing brain injuries in children.

Vets with Brain Injuries Deserve Purple Hearts, Advocates Argue

As combat operations continue to wind down in Afghanistan, advocates argue that soldiers returning home with traumatic brain injuries deserve to be awarded Purple Hearts. The signature wound of war is invisible to the naked eye yet it leaves dramatic traces on the lives of soldiers. In a recent editorial in The Oregonian, Elizabeth Hoyde tells a striking story of her own struggle with brain injury and explains why veterans deserve to be recognized for their sacrifice.

Efforts to recognize the sacrifice of soldiers with TBIs were well underway in September when the Army awarded Purple Hearts to almost 1,000 soldiers with traumatic brain injuries.

Even Mild Concussions Harm Brain’s Resting Mode

A recent study reveals new information about the long-term damaging effects of mild traumatic brain injuries. The study, published in the journal Radiology, suggests that concussions can upset the brains “default mode”, or the time the brain uses for information processing and maintenance. Disruption of the default mode could be associated with the development of long-term postconcussive symptoms.

To understand the effects of mild TBIs on the brain’s default mode, researchers compared the brains of 18 healthy controls with 23 patients with posttrauamtic symptoms within the first two months of injury.

When compared to healthy participants, those with posttrauamtic symptoms soon after a mild traumatic brain injury had reduced connectivity in some regions of the brain, and increased connectivity in the parts of the brain involved in the default mode. These abnormalities were linked to poor cognitive functioning and reduced mental flexibility.

Among the abnormalities detected with functional MRIs, TBI patients showed signs of increased activity in the medial prefrontal cortex. This region of the brain is involved in social function, self-relevance, and quick judgment of errors. Increased activity in the medial prefrontal cortex has been observed in patients with severe and moderate TBIs in other studies, and is believed to contribute to the brain’s recovery process. But if this hyper activation persists for too long, it could lead to ongoing psychological problems, depression, anxiety, and fatigue, the researchers wrote.

The study adds to our understanding of the long-term consequences of mild traumatic brain injuries. It also suggests that resting functional MRIs can be used to detect subtle brain injuries that are typically not observable with conventional imaging techniques.


Zhou Y, et al. Default-Mode Network Disruption in Mild Traumatic Brain Injury. Radiology 2012; 265: 882-892.


Documents Reveal Contradictions of NFL’s Handling of Head Injuries

The NFL awarded disability payments to at least three former football players suffering from debilitating brain injuries, according to previously unpublished documents only recently made public. The documents obtained by an ESPN and Frontline investigation show that the league awarded at least $2 million in disability benefits to former football players in the late 1990s and early 2000s. All the while, the league’s top medical experts continued to deny any link between long-term brain damage and football.


Brain Injury and Herbicide Linked to Parkinson’s Disease

People with a history of head injuries and exposure to the herbicide paraquat were three times more likely develop Parkinson’s disease in a new survey published in the journal Neurology.

Researchers believe that a head injury could make brain cells vulnerable to the toxic pesticide. While this survey isn’t enough to draw conclusions, it does raise questions about the role of head trauma and pesticides in the development of Parkinson’s disease.

Whiplash patients aren’t “cured by verdict”, study finds

A new study sought to investigate whether whiplash claimants exaggerate their symptoms in an effort to maximize their injury compensation. Researchers analyzed data on claim settlement timing and neck pain scores. They found that “removing the financial incentive” of the claim did not significantly alter neck pain scores, suggesting that patients do not systematically misrepresent their health status for financial gain.

Athletes Downplay Concussion Symptoms

Last week Chicago Bears’ linebacker Brian Urlacher admitted that he would lie about a concussion to stay in the game. Sadly, he’s not the only one.

As awareness around concussions grows in sports, Urlacher’s comment shows there’s still significant work needed to change the culture of football, David Haugh argues in a recent article in the Chicago Tribune.

Athletes, often concerned with returning to the game s soon as possible, may find it tempting to downplay their symptoms. That’s why doctors should remind athletes that returning to play too soon after a concussion can have devastating consequences for your brain, particularly in young athletes.

Kids and Concussions: How long should they rest?

Awareness around brain injuries in youth sports has surged in recent years as new research demonstrates the dangers of repeat concussions for young athletes. But as coaches, doctors, and parents scramble to protect athletes, questions remain about how best to manage and treat youth concussions. How long should an athlete wait before returning to play? Can every athlete resume activities after the same amount of time or do some patients require more rest?

Previous studies show that repeat TBIs exacerbate injury symptoms. But research suggests that the risk associated with repeat TBIs drops significantly after a certain amount of time.

Researchers from the UCLA School of Medicine found that there appears to be a certain “window of vulnerability” following a brain injury in juvenile brains. As the brain works to heal, there’s a sharp reduction in glucose metabolism levels. Decreased levels of glucose metabolism have been tied to functional deficits, damaged axons, and decreased in connectivity synapses of the brain.

When lab rats were subjected to brain injuries in the study, their glucose metabolism dropped significantly, as predicted. These levels tended to normalize within three days. But if rats were exposed to another brain injury before then, their glucose metabolism reached new lows, suggesting that even greater damaged occurred.

These findings suggest that the juvenile brain may begin to show signs of improvement within a few days after an injury . However, researchers pointed out that previous studies have indicated that recovery time is longer depending on the severity of the injury and the patient’s age. More research is needed to draw firm conclusions on the recommended rest time after a brain injury, but this study brings us closer to developing age-appropriate guidelines for concussion recovery.

And despite that young brains may show signs of decreased vulnerability within a few days following an injury, research shows that even mild brain injuries can produce lasting cognitive deficits.

Soccer Players Risk Brain Damage

Soccer may seem like a relatively-low risk sport when it comes to concussions, but new research suggests that even soccer players are at risk of incurring brain damage. Heading the ball, jamming into other players, and falling all expose players to dozens of opportunities for minor hits to the head throughout a game. Although those minor hits may not cause a cause a concussion, over time, they can add up to damage the brain.

Researchers compared elite male soccer players who frequently head the ball to a group of competitive swimmers who were unlikely to expose themselves to minor head trauma. The soccer players showed signs of negative changes to the white matter of the brain, similar to changes observed in patients with mild traumatic brain injuries. These changes occurred despite that none of the players had a history of concussions.

Previous research suggests that repetitive brain injuries can lead to cognitive deficits and the degenerative brain disease, chronic traumatic encephalopathy or CTE. Less is known about the long-term consequences of frequent, sub-concussive head trauma however.

And despite that concussions may be less common in soccer than in other contact sports, the risk for concussions is still present, particularly in girls’ soccer.