Screening for psychiatric illness in patients with oral dysesthesia by means of the General Health Questionnaire--twenty-eight item version (GHQ-28) and the Irritability, Depression and Anxiety Scale (IDA)

Local anesthesia nerve block for managing burning mouth syndrome: a scoping review

OBJECTIVE

To assess the clinical scenarios in which nerve blocks are employed in the context of burning mouth syndrome (BMS).

STUDY DESIGN

This scoping review followed the PRISMA-ScR. A protocol was generated on Open Science Framework. Electronic searches were performed in the following databases: PubMed, Scopus, EMBASE, Web of Science, LILACS, and Cochrane, in addition to the grey literature and citations from Grémeau-Richard et al. (2010).

RESULTS

Nerve blocks were used for treatment purposes in all cases. The mandibular nerve and the stellate ganglion were both blocked in 50% studies, while the maxillary nerve and lingual nerve were blocked in 25% study each. The anesthetics used were lidocaine (50%) and bupivacaine (50%). Relief was generally reported after immediate block, and at a mean follow-up of 4.5 weeks, there was considerable improvement compared to the initial conditions when the mandibular and/or maxillary nerve were targeted.

CONCLUSIONS

The use of nerve blocks has been employed in the treatment of patients with refractory BMS. Clinical studies with standardized methodology are necessary to validate and understand the potential role of mandibular and maxillary nerve block in this setting.

The Psychological Nursing Interventions Based on Pygmalion Effect Could Alleviate Negative Emotions of Patients with Suspected COVID-19 Patients: a Retrospective Analysis

PURPOSE

This study aims to explore the psychological status of suspected COVID-19 patients during quarantine and put forward a new yet effective psychological nursing strategy for intervention.

PATIENTS AND METHODS

We performed a retrospective study with suspected COVID-19 patients who were hospitalized to the two hospitals of Hunan province, China and accepted the intervention of psychological nursing from 01/2020 to 03/2020. The control group received routine psychological nursing care and the observation group received the new psychological nursing intervention according to Pygmalion effect.

RESULTS

A total of 89 objects were included in the analysis. Results of the questionnaire before intervention showed that the majority of isolated suspected COVID-19 patients showed negative emotions, with the incidence of depression (51.69%), anxiety (14.617%), inverted provocation (22.47%), extraverted provocation (25.84%). And the extraverted provocation scores of female patients was significantly higher than that of male counterparts (P < 0.05). At discharge, compared with the control group, the scores of depression, anxiety, introversion and extraversion of patients in the observation group were significantly lower after nursing intervention based on Pygmalion effect. The satisfaction rate of psychological care based on Pygmalion effect was 86.66%.

CONCLUSION

Suspected COVID-19 patients tend to show the symptoms of depression, anxiety and irritation during quarantine. The psychological nursing based on Pygmalion effect is helpful to alleviate their negative emotions.

Burning mouth syndrome

Objective

To review the clinical entity of primary burning mouth syndrome (BMS), its pathophysiological mechanisms, accurate new diagnostic methods and evidence-based treatment options, and to describe novel lines for future research regarding aetiology, pathophysiology, and new therapeutic strategies.

Description

Primary BMS is a chronic neuropathic intraoral pain condition that despite typical symptoms lacks clear clinical signs of neuropathic involvement. With advanced diagnostic methods, such as quantitative sensory testing of small somatosensory and taste afferents, neurophysiological recordings of the trigeminal system, and peripheral nerve blocks, most BMS patients can be classified into the peripheral or central type of neuropathic pain. These two types differ regarding pathophysiological mechanisms, efficacy of available treatments, and psychiatric comorbidity. The two types may overlap in individual patients. BMS is most frequent in postmenopausal women, with general population prevalence of around 1%. Treatment of BMS is difficult; best evidence exists for efficacy of topical and systemic clonazepam. Hormonal substitution, dopaminergic medications, and therapeutic non-invasive neuromodulation may provide efficient mechanism-based treatments for BMS in the future.

Conclusion

We present a novel comprehensive hypothesis of primary BMS, gathering the hormonal, neuropathic, and genetic factors presumably required in the genesis of the condition. This will aid in future research on pathophysiology and risk factors of BMS, and boost treatment trials taking into account individual mechanism profiles and subgroup-clusters.

Biopsychosocial aspects of atypical odontalgia

Background. A few studies have found somatosensory abnormalities in atypical odontalgia (AO) patients. The aim of the study is to explore the presence of specific abnormalities in facial pain patients that can be considered as psychophysical factors predisposing to AO. Materials and Methods. The AO subjects (n = 18) have been compared to pain-free (n = 14), trigeminal neuralgia (n = 16), migraine (n = 17), and temporomandibular disorder (n = 14). The neurometer current perception threshold (CPT) was used to investigate somatosensory perception. Structured clinical interviews based on the DSM-IV axis I and DSM III-R axis II criteria for psychiatric disorders and self-assessment questionnaires were used to evaluate psychopathology and aggressive behavior among subjects. Results. Subjects with AO showed a lower Aβ, Aδ, and C trigeminal fiber pain perception threshold when compared to a pain-free control group. Resentment was determined to be inversely related to Aβ (rho: 0.62, P < 0.05), Aδ (rho: 0.53, P < 0.05) and C fibers (rho: 0.54, P < 0.05), and depression was inversely related with C fiber (rho: 0.52, P < 0.05) perception threshold only in AO subjects. Conclusion. High levels of depression and resentment can be considered predictive psychophysical factors for the development of AO after dental extraction.

Self-reported oral complaints in older mentally ill patients

AIM

The aim of this study was to investigate the prevalence of self-reported oral complaints in older hospitalized mentally ill patients and relate them to the primary psychiatric diagnosis.

METHODS

A total of 89 older hospitalized psychiatric patients consented to participate in the study, and were interviewed and clinically examined. The medical data were obtained from the hospital's medical records.

RESULTS

The mean age of the patients was 73 years (range 59-94 years). A total of 54% suffered from psychotic disorders, 26% from dementia and 20% from mood disorders. The most common oral complaint was xerostomia (45%), followed by dysgeusia (28%), oral malodor (26%), pain when chewing (25%), burning mouth (23%), chewing difficulties (12%) and sialorrhoea (2%). The prevalence of burning mouth, dysgeusia and oral malodor differed significantly among psychiatric diagnoses and was increased in patients with mood disorders. A close association was recorded between burning mouth, dysgeusia, xerostomia and oral malodor complaints. Stepwise logistic regression showed that the use of antidepressants and burning mouth complaints were significantly associated with mood disorders.

CONCLUSIONS

An increased prevalence of oral complaints was recorded in the elderly psychiatric patients with mood disorders. Those patients should be systematically evaluated and managed for oral complaints, and particularly for burning mouth. The close association between burning mouth complaints and mood disorders requires further investigation to clarify the potential diagnostic value of the symptom for mood disorders.

Burning mouth syndrome: the efficacy of lipoic acid on subgroups

OBJECTIVE

We have examined the effect of alpha-lipoic acid (ALA, tioctic acid; Tiobec), a free radical scavenger, on the discomfort of burning mouth syndrome (BMS) in patients who had used tranquillizers previously, compared with those who had not.

METHODS

In this study we gave lipoic acid for 2 months to two groups of 20 BMS patients, one of which had previously been treated with tranquillizers.

RESULTS

The results showed greater effectiveness of lipoic acid in BMS patients who had not previously used tranquillizers.

CONCLUSIONS

The patients with BMS who had previously been treated with tranquillizers responded poorly to therapy with lipoic acid compared with those who had not received previous psychotropic therapy.

Topical clonazepam in stomatodynia: a randomised placebo-controlled study

Stomatodynia is characterised by a spontaneous burning pain in the oral mucosa without known cause or recognised treatment. The purpose of this double-blind, randomised, multicentre parallel group study was to evaluate the efficacy of the topical use of clonazepam. Forty-eight patients (4 men and 44 women, aged 65+/-2.1 years) were included, of whom 41 completed the study. The patients were instructed to suck a tablet of 1 mg of either clonazepam or placebo and hold their saliva near the pain sites in the mouth without swallowing for 3 min and then to spit. This protocol was repeated three times a day for 14 days. The intensity was evaluated by a 11-point numerical scale before the first administration and then after 14 days. Two weeks after the beginning of treatment, the decrease in pain scores was 2.4+/-0.6 and 0.6+/-0.4 in the clonazepam and placebo group, respectively (P = 0.014). Similar effects were obtained in an intent-to-treat analysis (P = 0.027). The blood concentration of clonazepam was similar whether it was measured 14 days after sucking a tablet three times a day or during the 5 h that followed sucking a single tablet (n = 5). It is hypothesised that clonazepam acts locally to disrupt the mechanism(s) underlying stomatodynia.

Psychological profile in burning mouth syndrome

Thirty-two patients with burning mouth syndrome and 32 matched control subjects were evaluated for their personality profile using a comprehensive, reliable, and validated inventory. All subjects were requested to complete the Neo PI-R questionnaire that measures the 5 dimensions of personality and their facets. A t-test and univariate correlations (Pearson's correlation coefficient) were used to compare the 2 groups. Results show high significant differences in some personality factors. Neuroticism and all its facets, which include anxiety, angry hostility, depression, self-consciousness, impulsiveness and vulnerability, were significant at P<.001. Other domains like extraversion, openness, and conscientiousness showed significant differences also (P<.05). Many personality characteristics differentiate burning mouth syndrome patients from controllers according to the Neo PI-R and this should affect the treatment plan according to the identified characteristics.

A preliminary communication on whether general dental practitioners have a role in identifying dental patients with mental health problems

OBJECTIVE

To examine whether general dental practitioners regard themselves as having a role in identifying dental patients with mental health problems.

METHOD

Telephone interviews were conducted with, and postal questionnaires were sent to, a random sample (n = 94) of general dental practitioners on Health Authority lists within the Mersey Region. A total of 84 general dental practitioners responded, resulting in an 89% response rate.

RESULTS

The majority of general dental practitioners had encountered patients with mental health problems (78% of interviewees, 56% of questionnaire responders). However, nearly half of the interviewees (46%) do not refer patients with mental health problems. When referrals to dental specialists were made, they tended to be regarding a physical manifestation rather than a psychological one. The majority of interviewees and questionnaire responders (55% and 82% respectively) expressed a 'positive' response to the development of a referral role. Nevertheless, there were some reservations concerning the practicalities of its development and implementation.

CONCLUSION

The majority of general dental practitioners consider a role in identifying patients with possible mental health problems. This role might include, being able to identify patients with undiagnosed mental health problems, and being aware of dental conditions which may be caused by mental health problems. To achieve this, inter-professional co-operation between general dental practitioners and other health professionals requires development.

Companion cats and the social support systems of men with AIDS

60 male pet owners with AIDS were given a formal questionnaire including items related to demographic, lifestyle, and pet ownership, as well as the Comfort from Companion Animals Scale, the Revised UCLA Loneliness Scale, and the General Health Questionnaire (GHQ-28). The men lived in the San Francisco area and received assistance from Pets Are Wonderful Support (PAWS), a community organization, in caring for their companion dogs or cats. Participants were a convenience sample of pet owners who volunteered from among 500 PAWS clients and who do not necessarily represent a random sample of men with AIDS who keep companion animals. For these men, their comfort from companion animals was significantly associated with having cats but not dogs, closeness with friends, dissatisfaction with their practical support system, and listing pets as a source of support. Loneliness was negatively associated with having a large practical support network, scoring as healthy on the General Health Questionnaire, and living alone. For these male pet owners with AIDS, pet cats appeared to complement their supportive relationships with friends and family that were protective against loneliness.

Burning mouth syndrome (BMS): controlled open trial of the efficacy of alpha-lipoic acid (thioctic acid) on symptomatology

BACKGROUND

Alpha-lipoic acid (ALA), is a potent antioxidant mitochondrial coenzyme, the trometamol salt of thioctic acid that has been shown in clinical studies to be neuroprotective. This study examined the effect of ALA on the symptomatology of Burning mouth syndrome (BMS).

SUBJECTS AND METHODS

Forty-two patients with BMS and no clinical or laboratory evidence of organic oral disease were divided into two groups (Test and Control) each of 21 subjects, matched for age and sex. The Test group were given ALA (thioctic acid; Tiobec) for 30 days, as 600 mg per day orally for 20 days followed by 200 mg per day for 10 days. The Control group were given cellulose starch 100 mg per day as placebo for 30 days. All BMS patients were reviewed at 10-day intervals and scored for changes in symptomatology.

RESULTS

Significant improvements were shown in the symptomatology of BMS in up to two-thirds of patients with BMS receiving alpha-lipoic acid, in about 15% of those using placebo and also in up to two-thirds of those who, having tried placebo, were switched to ALA.

Psychiatric comorbidity in patients with burning mouth syndrome

OBJECTIVE

The goal of this study was to evaluate the prevalence and type of psychiatric disorders coexisting with burning mouth syndrome (BMS), to compare the clinical features of patients with BMS alone with patients with multiple diagnoses, and to investigate the number and severity of life events that occur before the onset of BMS.

METHOD

There were 102 patients with BMS, with no possible local or systemic causes, who were evaluated according to the diagnostic criteria of DSM-IV. All axis I diagnoses for which the patients met criteria at intake or lifetime were determined. Life events were evaluated for a period of 6 months before the onset of BMS. A statistical comparison between patients and a matched control group was performed first; moreover, patients with BMS alone were compared with patients with comorbid BMS.

RESULTS

Although 29 (28.4%) BMS patients were not given any other lifetime psychiatric diagnosis, high rates of comorbid psychiatric diagnoses were found. The most prevalent concurrent diagnoses were depressive disorders and generalized anxiety disorder. No significant differences emerged in clinical features between patients with and without other current psychiatric disorders. The severity of life events, rather than in their number, was significantly associated with BMS.

CONCLUSIONS

BMS has high psychiatric comorbidity but can occur in the absence of psychiatric diagnoses.

Burning mouth syndrome (BMS) and the concept of alexithymia--a preliminary study

Twenty women suffering from burning mouth syndrome (BMS) were rated with regard to alexithymic traits, depressive symptoms and anxiety; values were compared to disability level assessed by interviews. Results confirm earlier reports that BMS symptomatology is associated with depression and anxiety. The majority of patients were rated as alexithymic and, supported by interview data; these results indicate that somatization should be taken into consideration during clinical evaluation of BMS symptoms. The study included a psychological analysis of the communication pattern in the patient-doctor relationship, leading to the assumption that the patient's appeal for somatic treatment, dependency and hopelessness may activate defensive reactions in the dentist. Such reactions can be either rejection of, or compliance with, the patient's demands. The importance of a differentiated assessment and treatment approach for these patients is emphasized. Due to lack of control data the report should be viewed as a pilot study.

Burning mouth syndrome

BACKGROUND AND OBJECTIVES

Burning mouth syndrome (BMS) is a frequent process that produces marked oral dysesthetic symptoms. There is controversy over its etiopathogenesis and diagnosis. Therapeutic results are unsatisfactory. The objectives of this study were: (1) to analyze a possible agreement on the definition of BMS; (2) to analyze its cause; (3) to propose a therapeutic scheme that has been shown to be highly effective in our experience and has not been previously reported.

METHODS

Five hundred patients with symptomatology of BMS were retrospectively evaluated with a study protocol, specially designed for this disease. Patients with local or general disease processes that could cause secondary asymptomatic stomatodynia were excluded from the study.

RESULTS

Most of the patients evaluated were women over 60 years of age with oral symptoms, including a sensation of heat and burning, and pain, lasting for months or years, and a history of multiple unsuccessful treatments. The patients showed depression associated with anxiety, with evidence of psychiatric disorders in the family. Based on these findings and eliminating symptomatic painful conditions of the mouth that may stimulate this syndrome, we diagnosed a genuine or basic BMS of psychosomatic origin. Therapies used in the treatment of these neurotic conditions were not always useful. Tranylcypromine associated with anxiolytics and hypnotics in low doses plus the support of psychotherapy by the stomatologist were the most effective treatments.

CONCLUSIONS

The BMS should be defined as a psychosomatic process causing oral dysesthesias for months or years.

Personality characteristics of patients with resistant burning mouth syndrome

The personality characteristics in 32 patients with resistant burning mouth syndrome (BMS) after treatment of diagnosed medical and odontologic diseases were examined and compared with a sex- and age-matched control group. After evaluation of burning mouth symptoms, the personality, the psychologic functioning, and the quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). The result showed that, compared with a control group, the patients with resistant BMS had a significantly lower score in socialization scale and significantly higher scores in somatic anxiety, muscular tension, and psychasthenia scales. Furthermore, the patients with resistant BMS were significantly more easily fatigued and more sensitive and showed a tendency to be more concerned about their health. With regard to the psychologic functioning, the BMS patients had significantly more problems taking the initiative, more easily became dizzy, and had more sad thoughts. They also showed a tendency to report palpitations and/or indigestions more often. The observed significant differences in personality and psychologic functioning might suggest that the burning sensations are psychosomatic symptoms in these patients. We recommend that patients with resistant BMS should undergo psychologic investigation. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered.

Clinical study of patients with burning mouth

Analysis and treatment of dental and medical factors that can cause burning mouth were performed in 25 consecutive patients according to a treatment protocol. The effect of the dental and medical treatment on the burning mouth was evaluated. The sick leave profile was presented. Apart from burning mouth symptoms, the patients reported several oral and general symptoms, such as gustatory changes, xerostomia, back and joint muscle pain, headache, and dizziness. The most common dental diagnoses were temporomandibular joint, masticatory, and tongue muscle dysfunction and lesions in the oral mucosa. The most common medical diagnoses were low serum iron and hypersensitive reaction to mercury. None of the patients tested exceeded the limit of 100 nmol Hg/l urine. Replacement of amalgam fillings was the most common dental therapy, followed by treatment of dysfunction in the masticatory system. Iron replacement was the most frequent medical treatment. The patients had over 50% more days per year sick leave than an age- and sex-matched normal population. A follow-up found that the burning mouth had disappeared in 32% of the patients. This study confirms the opinion that burning mouth is multicausal. Hypersensitive reaction to mercury was more frequent than expected, but replacement of amalgam fillings relieved burning mouth in only two of five such patients, and one of these two patients had hypersensitive reactions to both mercury and gold. One reason that so many patients continued to have burning mouth might have been neglect of dental, medical, or both diagnoses. Another reason might be that assessment of the psychologic status of the patients and psychologic treatment when indicated were not done.

Prevalence of psychopathology in burning mouth syndrome. A comparative study among patients with and without psychiatric disorders and controls

Forty-nine patients with burning mouth syndrome were simultaneously evaluated through a psychiatric interview and a psychopathologic questionnaire (SCL-90). The same protocol was applied to a control group (n = 47) free of oral complaints and with a similar age and sex distribution. The subgroup with burning mouth syndrome and associated psychiatric disorders differed from the subgroup of patients without psychiatric disorders in that the former exhibited significantly more symptoms of anxiety, depression, obsession, somatization, and hostility. This latter parameter appears to be present particularly among depressed persons. No significant psychopathologic differences were observed between the subgroup with BMS who exhibited no psychiatric disorders and the controls who were free of oral disorders.

Description of persons with symptoms presumed to be caused by electricity or visual display units--oral aspects

A questionnaire containing 20 questions was sent to 127 members of the Association for Those Injured by Electricity and Visual Display Units in northern Sweden, of whom 103 (81%) answered. The questionnaire consisted of questions about age, sex, and place of work. Furthermore, the members were asked to state: 1) their general and oral symptoms; 2) whether they thought that dental amalgam and other types of dental filling materials had affected their symptoms; 3) whether they were replacing or had replaced their amalgam fillings and, if so, what effect it had had on their symptoms; 4) whether they had been medically examined; and 5) whether they were or had been sick-listed for their complaints. Of those who answered the questionnaire, 79% were women (mean age 45 yr) and 21% men (mean age 42 yr). Sixty percent worked in offices. In 82%, the symptoms had started at work. The mean duration of the symptoms was 5.2 yr. The symptoms were aggravated mostly in "electric environment in general" and in "office with computers". Skin complaints, fatigue, and eye symptoms were the most common general symptoms. Sixty-five percent mentioned that they had oral symptoms. Gustatory disturbances, burning mouth, and temporomandibular joint (TMJ) dysfunction were the most common oral symptoms. Fifty-six percent considered that dental amalgam and 24% that other dental materials affected the symptoms. Twenty-one percent were in the process of replacing the amalgam fillings; 40% had already done so. After replacement, 37% had noticed a decrease of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Antecedents of burning mouth syndrome (glossodynia)--recent life events vs. psychopathologic aspects

Burning mouth syndrome--BMS (also known as glossodynia, glossalgia, glossopyrosis, or oral dysesthesia)--primarily affects middle-aged women. Many possible etiologies have been proposed to account for the syndrome; most are still unsubstantiated. One possible suggested etiology involves the presence of psychological components. In this study, 45 BMS patients and 45 age-, sex-, ethnic origin-, socio-economic status-, and education-matched control subjects were evaluated for their psychopathologic profile and existence of recent life events. All subjects were requested to complete the SCL-90 questionnaire and a Recent Life Changes questionnaire. The BMS patients scored significantly higher on all SCL-90 scales except one. A MANOVA test to evaluate the overall group effect was significant at the 0.0001 level. No differences between groups were found for recent life events. The data suggest that although BMS patients are subjected to elevated psychological stress, initiation of BMS symptoms is not necessarily correlated with stressful life events.

Dental management of the geriatric patient with major depression

Major depression is a psychiatric disorder in which mood, thought content, and behavioral patterns are impaired, often for an extended period of time. The condition is encountered among elderly persons admitted to the hospital and those residing in nursing homes. Major depression is predominantly biologic in origin and may arise from dysfunction of the limbic-hypothalamic-pituitary-adrenal axis. It is associated with personal neglect, including a disinterest in performing appropriate preventive oral hygiene techniques. The majority of antidepressant medications cause xerostomia and magnify the incidence of dental disease. Appropriate dental management of patients with the disorder necessitates the use of anti-caries agents containing fluoride, saliva substitutes, and special precautions when analgesics and local anesthetics are being prescribed or administered. Dental treatment helps to improve the patient's self-image and quality of life.

Burning mouth syndrome: literature review and model for research and management

The literature on burning mouth syndrome (BMS) is reviewed with particular reference to its prevalence, local and systemic etiologic factors, psychogenic background and treatment. Research requirements are discussed, which focus on different clinical and psychological parameters and the necessity to evaluate BMS. Finally, a treatment protocol including oral, medical and psychological investigations is presented.

Psychiatric morbidity in burning mouth syndrome. Psychiatric interview versus depression and anxiety scales

Seventy-four patients with burning mouth syndrome underwent a psychiatric interview; Hamilton's Depression and Anxiety Scales were applied independently. A psychiatric diagnosis was established in 38 cases (51.35%). Depression was the predominant disorder. The evaluation scales showed that when present, anxiety greatly influences the psychiatric condition of these patients. The differences in the results obtained with the two methods are discussed.

Clinical characteristics and management outcome in the burning mouth syndrome. An open study of 130 patients

Clinical characteristics and treatment responses were studied in 130 patients with burning mouth syndrome (BMS). Most patients were postmenopausal women, and the tongue was the most frequently afflicted site. Although 39% of the patients complained of dry mouth, no causative factors were evident. Therefore BMS is assumed to be a functional disorder. This was at least partially confirmed because the most effective management was in response to mood-altering drugs. From our data BMS appears to be a chronic condition with variations in symptoms among patients and without a predictable endpoint.

Dental management of the patient with major depression

Major depression is a psychiatric disorder in which mood, thought content, and behavioral patterns are impaired for long periods of time. It is a common disorder, with an increasing prevalence among young adults. It may be associated with a disinterest in performing appropriate preventive oral hygiene techniques, a cariogenic diet, diminished salivary flow, rampant dental decay, advanced periodontal disease, and oral dysesthesias. Many medications used to treat the disease magnify the xerostomia and increase the incidence of dental disease. Appropriate dental management necessitates a vigorous preventive dental education program, the use of saliva substitutes and anticaries agents containing fluoride, and special precautions when prescribing or administering analgesics and local anesthetics.

Low power laser biostimulation of chronic oro-facial pain. A double-blind placebo controlled cross-over study in 40 patients

The efficacy of low power laser stimulation in the treatment of chronic oro-facial pain conditions was investigated in a double-blind placebo controlled modified cross-over study in 40 patients. The laser was an invisible infrared (IR) diode laser with an emission at 904 nanometer (nm). Treatment effect was evaluated by means of VAS-scales and global assessment of pain. Outcome of treatment was correlated to changes in urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA). The clinical impression was that placebo was superior to laser stimulation. No statistically significant difference between the analgesic effect of the laser and placebo irradiation was found on VAS-scales. A significant (P = 0.05) increase in 5-HIAA excretion was found in the placebo group. It is concluded that the possibility of a substantial placebo response should be taken into consideration using 904 nm (IR) lasers for pain treatment in patients with this type of chronic oro-facial pain.