Five Patients With Burning Mouth Syndrome in Whom an Antidepressant (Serotonin-Noradrenaline Reuptake Inhibitor) Was Not Effective, but Pregabalin Markedly Relieved Pain

Amitriptyline effectiveness in burning mouth syndrome: An in-depth case series analysis

OBJECTIVES

To assess the effectiveness of amitriptyline (AMT), and to identify the determinants of the treatment's effectiveness in patients diagnosed with burning mouth syndrome (BMS).

BACKGROUND

Treatment of BMS is challenging and no established treatment protocol is available. AMT may be an important treatment option, cout not all patients benefit from this drug. Studies assessing factors related to treatment response are valuable in improving decision-making.

MATERIALS AND METHODS

This case series study examined the medical records of all patients diagnosed with BMS at an oral medicine unit in a university hospital from 2008 to 2022. The patients were divided into responders to AMT and non-responders to AMT. Data on demographic information, comorbidities, medications, types of symptoms and oral subsites affected were collected. Descriptive and bivariate analyses were conducted to assess the association between the independent variables and the outcome, using the Chi-squared test (P < .05).

RESULTS

Three hundred and fourty-nine patients reported a burning mouth sensation, 50 of them (14.3%) being diagnosed with primary BMS. Of these, 35 were treated with AMT, and 26 (74.2%) responded significantly to AMT. All males responded to AMT, whereas only 67.9% of females responded. The mean dose of AMT among responders was 29.8 ± 12.3 mg, with most patients achieving a response with 25 mg (61.5% of patients), followed by 50 mg (23%). The concomitant use of an anticonvulsant resulted in non-response.

CONCLUSIONS

AMT may be effective in BMS management for most patients.

Insight into the Role of Psychological Factors in Oral Mucosa Diseases

With the development of psychology and medicine, more and more diseases have found their psychological origins and associations, especially ulceration and other mucosal injuries, within the digestive system. However, the association of psychological factors with lesions of the oral mucosa, including oral squamous cell carcinoma (OSCC), burning mouth syndrome (BMS), and recurrent aphthous stomatitis (RAS), have not been fully characterized. In this review, after introducing the association between psychological and nervous factors and diseases, we provide detailed descriptions of the psychology and nerve fibers involved in the pathology of OSCC, BMS, and RAS, pointing out the underlying mechanisms and suggesting the clinical indications.

Burning mouth syndrome: a review of therapeutic approach

Burning mouth syndrome (BMS) is described by an intense burning sensation of the tongue or other oral areas without a clear etiopathology. The diagnosis of BMS is challenging due to variations of manifestations. The management of BMS is complicated due to the complex etiology of the disease. Many medications and treatment methods have been recommended for BMS management, but no one confirmed as the standard method. In this study, the therapeutic approaches of BMS were evaluated. The data of the article was obtained from PubMed/MEDLINE, Cochrane Library, and Web of Science. The following terms including "burning mouth syndrome", "therapy", and "treatment" were used for search in the databases. A wide range of articles about the therapeutic approach of BMS was searched and reviewed. Pharmacological and non-pharmacological approaches have been used for BMS management. Pharmacological treatments are including Capsaicin, Clonazepam, Low-dose aripiprazole, Alpha-lipoic acid, Duloxetine, Amitriptyline, Gabapentin, and Pregabalin, and ultra-micronized palmitoylethanolamide. Non-pharmacological therapies for BMS are cognitive therapy, Electroconvulsive therapy, Laser therapy, Acupuncture and auriculotherapy, Transcranial Magnetic Stimulation (rTMS), Salivary Mechanical Stimulation, and Botulinum Toxin. A detailed assessment of the etiology and pathophysiology of BMS, and having information about novel therapeutic interventions are essential for the management of BMS.

Vortioxetine in the Treatment of Mood Disorders Associated with Burning Mouth Syndrome: Results of an Open-Label, Flexible-Dose Pilot Study

OBJECTIVE

To evaluate the efficacy of a new multimodal antidepressant, vortioxetine (VO), in the management of burning mouth syndrome (BMS).

DESIGN

Longitudinal single-assessment open-label pilot study.

SETTING

University hospital. Subjects. Thirty BMS patients were enrolled.

METHODS

BMS patients were treated with topical clonazepam and a flexible dose of VO (10 mg, 15 mg, or 20 mg). The visual analog scale (VAS), the Total Pain Rating Index (T-PRI), the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A), and the Pittsburgh Sleep Quality Index (PSQI) were performed at baseline (time 0) and after two (time 1), four (time 2), six (time 3), and 12 months (time 4) of treatment. Descriptive statistics and the Wilcoxon nonparametric test for two paired samples were used.

RESULTS

The BMS patients showed a statistically significant improvement in VAS and T-PRI scores from baseline (median [interquartile range {IQR}] = 10.0 [10-10] and 22.0 [20-24], respectively) to time 4 (median [IQR] = 0.0 [0-0] and 8.0 [7-9], P < 0.001, respectively). Similarly, the HAM-A and HAM-D and PSQI scores showed an improvement from time 0 (median [IQR] = 20 [15.8-22], 19 [16-20.3], and 4.0 [4-7.3], respectively) to time 4 (median [IQR] = 6.0 [6-7], 6.0 [6-7], and 3.0 [3-4], respectively, P < 0.001).

CONCLUSIONS

VO is efficacious and well tolerated in the treatment of BMS in firstline therapy on account of its better receptor pharmacological profile and in second-line treatment for patients who have only partially responded or have reported adverse effects to previous treatments.

Evaluation of patients suffered from burning mouth syndrome and persistent idiopathic facial pain using Japanese version PainDETECT questionnaire and depression scales

BACKGROUND/PURPOSE

Various questionnaires have been validated as methods for screening of neuropathic pain, but none have been established for the orofacial region. Although chronic pain and depression are likely to comorbid, few studies have examined the relationship between orofacial chronic pain and depression. Therefore, we evaluated the potential of the Japanese Version of PainDETECT as an assessment tool for neuropathic pain associated with burning mouth syndrome (BMS) and persistent idiopathic facial pain (PIFP). We also evaluated the depression scale such as Beck's Depression Inventory (BDI: a subjective index) and Hamilton Depression Rating Scale (HDRS: an objective index) with BMS or PIFP.

MATERIALS AND METHODS

As a target, we administered the Japanese version of the PainDETECT questionnaire to the BMS (29 patients) and PIFP (17 patients). As a control, patients with post-extraction pain (typical nociceptive pain, (EXT) 16 patients) were also participated. We performed BDI and HDRS with BMS or PIFP.

RESULTS

Although PainDETECT final score was significantly higher in BMS [median: 10] compared with PIFP [6] and EXT [5] (p < 0.05), PainDETECT final scores for all groups were lower than the cutoff value for the possibility of neuropathic pain. HDRS was significantly higher in the BMS than the PIFP. There were no significant differences between the BMS and PIFP in BDI.

CONCLUSION

Under the limitations of current research design, the Japanese version of the PainDETECT questionnaire does not show sufficient potential as pain assessment tool for patients with BMS and PIFP. BMS is comorbid with depression objectively when compared with PIFP.

Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

Introduction: Gabapentinoids, pregabalin and gabapentin, neuronal voltage-gated calcium channel inhibitors are first-line treatments for painful neuropathic conditions (and several non-neuropathic painful conditions). Nevertheless, their efficacy and prescription in Oral Medicine and Oral Surgery practice has received little attention so far. A previous article, the first of a two-part series, presented the experience of a French tertiary orofacial pain clinic regarding the prescription of gabapentinoids in orofacial conditions. This second article aimed to explore the scientific literature on the subject. Material and methods: A systematic scoping review was conducted on multiple relevant databases (MEDLINE®, Cochrane®, Agence Nationale de Sécurité du Médicament et des produits de santé, Haute Autorité de Santé) and journal archives (JOMOS, JSOMFS) to assess the indications, non-indications and contraindications of gabapentinoids in an Oral Medicine/Oral Surgery context. Results: Out of 131 records selected during the initial screening, 34 matched the inclusion criteria and were used for subsequent analyses. Gabapentinoids were prescribed in three clinical contexts: orofacial pain management (32 studies), anxiolysis (1 study) and prevention of postoperative nausea/vomiting (1 study), with variable quality of evidence: high (6 studies), moderate (3 studies), low (5 studies) and very low (20 studies) quality studies (GRADE scale). Untoward effects of gabapentinoids were reported in 16 studies, mainly neurological (vertigo, drowsiness, sedation) and gastro-intestinal (nausea, vomiting, diarrhea, constipation). Gabapentinoids were ineffective in preemptive and postoperative analgesia and for the management of mucositis-related pain. Discussion: There is some evidence supporting the use of gabapentinoids in Oral Medicine/Oral Surgery in adherence with current practices observed in France and other countries (practices often extrapolated from their use in other non-orofacial painful conditions). The methodological quality of the studies included in this scoping review is often poor and publication bias is most probable in this field. Therefore, any conclusion drawn from such studies must be subject to circumspection. Conclusion: Data obtained from the present scoping review suggests the potential use of gabapentinoids as second-line treatments for anxiolysis, prevention of postoperative nausea/vomiting and the management of trigeminal neuralgia and masticatory myalgia. Other potential indications of gabapentinoids in Oral Medicine/Oral Surgery practice include cranial neuralgias, post-traumatic trigeminal neuropathies, first bite syndrome, burning mouth syndrome and migraine prophylaxis, when other treatment options are inefficient or unavailable.

Pain reduction in burning mouth syndrome (BMS) may be associated with selective improvement of taste: a retrospective study

OBJECTIVE

The aim of this study was to examine taste function in patients who reported improvement in their pain level after treatment to determine if pain reduction is associated with change in taste function in patients with burning mouth syndrome (BMS).

STUDY DESIGN

This retrospective study of patients with BMS was conducted at a private oral medicine clinic.

RESULTS

Thirty-nine patients with BMS (31 females and 8 males; mean age 56.1 ± 9.4 years) reported improvement in their pain in 1 to 22 months after the initial visit (mean 5.13 ± 4.18). The most commonly used medication was clonazepam 0.25 to 0.5 mg/day. Twenty-eight patients were treated with a combination of medications. "Salt" and "bitter" responses at the fungiform papillae were increased after treatment (P = .026 and P = .044, respectively). "Salt" responses at the circumvallate papillae also increased (P < .001). Pain reduction was significant after treatment in the morning (P = .002) and in the evening (P < .001).

CONCLUSIONS

Treatment of BMS can significantly decrease pain symptoms, resulting in improvement in taste function. Pain reduction often requires a combination of medications.

Effectiveness of Pregabalin for Treatment of Burning Mouth Syndrome

Treatment of burning mouth syndrome (BMS) is challenging because there is no consensus regarding pharmalogical or nonpharmalogical therapies. The use of anticonvulsants is controversial. We present nine patients BMS who respond to pregabalin. They were diagnosed secondary BMS except two. Etiologic regulations were made firstly in patients with secondary BMS but symptoms did not decrease. We preferred pregabalin in all patients and got good results. Furthermore the addition of pregabalin to the treatment of two patients who did not respond adequately to duloxetine provided good results. We are only aware that pregabalin may reduce symptoms as a result of case reports. We believe that the diagnosis of pathologic etiology with appropriate diagnostic tests will result in better outcomes in treatment.

Psycho-stomatodynia

Introduction:Burning mouth syndrome is an enigmatic condition whose etiopathogenic origin remains largely unknown and whose treatment remains unsatisfactory. It is often considered to be of “psychosomatic” origin, and this etiology is frequently reported in the French medical literature.Corpus:This narrative review examines the arguments supporting this point of view, in its historical, clinical, and therapeutic aspects, in order to shed light on the patientʼs point of view.Conclusion:The etiopathogenic uncertainty does not let us give the patient an erroneous conception of the affliction.

Effect of topical lidocaine in the oral and facial regions on tactile sensory and pain thresholds

OBJECTIVE

The aim of the present study was to examine the effect of lidocaine application to the face, tongue and hand on sensory and pain thresholds of symptom-free subjects.

DESIGN

Eighteen females (mean age 25.7 years, range 22-38) participated. Using Semmes-Weinstein monofilaments, the tactile detection threshold (TDT) and the filament-prick pain detection threshold (FPT) were measured on the cheek skin (CS), tongue tip (TT) and palm side of the thenar skin (TS). Subjects were tested in 2 sessions at a 1week interval in randomised order. Lidocaine (session A) or placebo gel (session B) was applied for 5min. The TDT and FPT were measured before and after application.

RESULTS

The TDT at all sites in session A significantly increased after 5min, but a significant session effect on the TDT was only found at the TT (P<0.01). On the other hand, there were significant session effects on the FPT at all sites (P<0.01).

CONCLUSION

These results indicate that the pain threshold (FPT) is more susceptible to local anesthetics than the sensory threshold (TDT), but further study is needed to use topical lidocaine for the control of oral and facial pain in the clinic.