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Gonçalves DR, Botelho LM, Carrard VC, Martins MAT, Visioli F. Amitriptyline effectiveness in burning mouth syndrome: An in-depth case series analysis. Gerodontology 2024. [PMID: 38515010 DOI: 10.1111/ger.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Douglas Rodrigues Gonçalves
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo Monteiro Botelho
- Pain Management and Palliative Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Vinícius Coelho Carrard
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Antônio Trevizani Martins
- Oral Medicine Unit, Otorhinolaryngology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Visioli
- Department of Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Nosratzehi T. Burning mouth syndrome: a review of therapeutic approach. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:83-90. [PMID: 34881535 DOI: 10.1515/jcim-2021-0434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Tahereh Nosratzehi
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Oral and Dental Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Amasyalı SY, Gürses AA, Aydın ON, Akyol A. Effectiveness of Pregabalin for Treatment of Burning Mouth Syndrome. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2019; 17:139-142. [PMID: 30690951 PMCID: PMC6361046 DOI: 10.9758/cpn.2019.17.1.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
| | - Aslı Akyol Gürses
- Department of Neurology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | | | - Ali Akyol
- Department of Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
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Gupta MA, Pur DR, Vujcic B, Gupta AK. Use of antiepileptic mood stabilizers in dermatology. Clin Dermatol 2018; 36:756-764. [DOI: 10.1016/j.clindermatol.2018.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lieb V, Rink M, Sikic D, Keck B. [Side effect management of tyrosine kinase inhibitors in urology : Gastrointestinal side effects]. Urologe A 2016; 55:805-12. [PMID: 27146873 DOI: 10.1007/s00120-016-0090-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For approximately one decade, tyrosinkinase inhibitors (TKIs, smart drugs) have dramatically changed and improved the treatment of patients suffering from metastasized renal cell carcinoma. However, the different drugs have substantial side effects. Especially gastrointestinal symptoms may be problematic for patients. These side effects represent a challenge for the physician. On the one hand, dosage modifications and treatment interruption should be avoided to minimize the risk for progression. On the other hand, only mild side effects are tolerable for the patient. Based on a literature review, a clear overview of the incidence of possible side effects for the drugs axitinib, cabozantinib, pazopanib, sorafenib, and sunitinib is provided. Furthermore, we give a practical guide on how to prevent and treat the different gastrointestinal side effects. Finally, it is pointed out when dosage modifications or interruption of treatment are necessary and how to expeditiously re-escalate the treatment after mitigation of side effects.
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Affiliation(s)
- V Lieb
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - M Rink
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - D Sikic
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - B Keck
- Urologische Universitätsklinik Erlangen, Universitätsklinikum Erlangen, Rathsberger Str. 57, 91054, Erlangen, Deutschland.
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Five Patients With Burning Mouth Syndrome in Whom an Antidepressant (Serotonin-Noradrenaline Reuptake Inhibitor) Was Not Effective, but Pregabalin Markedly Relieved Pain. Clin Neuropharmacol 2016; 38:158-61. [PMID: 26166242 DOI: 10.1097/wnf.0000000000000093] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Burning mouth syndrome (BMS) causes idiopathic pain or a burning sensation in clinically normal oral mucosa. Burning mouth syndrome is a chronic disease with an unknown etiology. Burning mouth syndrome is also idiopathic, and a consensus regarding diagnosis/treatment has not been reached yet. Recent studies have supported the suggestion that BMS is a neuropathic pain disorder in which both the peripheral and central nervous systems are involved. Tricyclic antidepressants (nortriptyline and amitriptyline), serotonin-noradrenaline reuptake inhibitors (SNRIs) (duloxetine and milnacipran), and antiepileptic drugs, potential-dependent calcium channel α2δ subunit ligands (gabapentine and pregabalin), are currently recommended as the first-choice drugs for neuropathic pain. In this study, we report 5 patients with BMS in whom there was no response to SNRI (milnacipran or duloxetine), or administration was discontinued because of adverse reactions, but in whom pregabalin therapy markedly reduced or led to the disappearance of pain in a short period. Pregabalin, whose mechanism of action differs from that of SNRIs, may become a treatment option for BMS patients who are not responsive to or are resistant to SNRIs.
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Abstract
Burning mouth syndrome (BMS) is a chronic pain condition. It has been described by the International Headache Society as "an intra-oral burning or dysesthetic sensation, recurring daily for more than 2 h/day for more than 3 months, without clinically evident causative lesions." BMS is frequently seen in women in the peri-menopausal and menopausal age group in an average female/male ratio of 7:1. The site most commonly affected is the anterior two-thirds of the tongue. The patient may also report taste alterations and oral dryness along with the burning. The etiopathogenesis is complex and is not well-comprehended. The more accepted theories point toward a neuropathic etiology, but the gustatory system has also been implicated in this condition. BMS is frequently mismanaged, partly because it is not well-known among healthcare providers. Diagnosis of BMS is made after other local and systemic causes of burning have been ruled out as then; the oral burning is the disease itself. The management of BMS still remains a challenge. Benzodiazepines have been used in clinical practice as the first-line medication in the pharmacological management of BMS. Nonpharmacological management includes cognitive behavioral therapy and complementary and alternative medicine (CAM). The aim of this review is to familiarize healthcare providers with the diagnosis, pathogenesis, and general characteristics of primary BMS while updating them with the current treatment options to better manage this group of patients.
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Affiliation(s)
- Cibele Nasri-Heir
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Rutgers, The State University, Newark, New Jersey 07101-1709, USA
| | - Julyana Gomes Zagury
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Rutgers, The State University, Newark, New Jersey 07101-1709, USA
| | - Davis Thomas
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Rutgers, The State University, Newark, New Jersey 07101-1709, USA
| | - Sowmya Ananthan
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Rutgers, The State University, Newark, New Jersey 07101-1709, USA
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Valença MM, de Oliveira DA, Martins HADL. Alice in Wonderland Syndrome, Burning Mouth Syndrome, Cold Stimulus Headache, and HaNDL: Narrative Review. Headache 2015; 55:1233-48. [DOI: 10.1111/head.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Marcelo M. Valença
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
- Neurology and Neurosurgery Unit; Hospital Esperança; Brazil
| | - Daniella A. de Oliveira
- Neurology and Neurosurgery Unit, Department of Neuropsychiatry; Federal University of Pernambuco; Brazil
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Bracarda S, Castellano D, Procopio G, Sepúlveda JM, Sisani M, Verzoni E, Schmidinger M. Axitinib safety in metastatic renal cell carcinoma: suggestions for daily clinical practice based on case studies. Expert Opin Drug Saf 2014; 13:497-510. [DOI: 10.1517/14740338.2014.888413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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A valid approach in refractory glossodynia: a single-institution 5-year experience treating with Japanese traditional herbal (kampo) medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:354872. [PMID: 24223055 PMCID: PMC3816042 DOI: 10.1155/2013/354872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/19/2013] [Accepted: 09/15/2013] [Indexed: 12/19/2022]
Abstract
Glossodynia is often refractory to conventional medicine, and there is only limited evidence to guide clinicians in its management. Patients with refractory glossodynia are often introduced to Japanese traditional herbal (Kampo) medicine experts under such circumstances because Kampo medicine has become known in Japan to be effective in treating a wide variety of symptoms refractory to conventional medicine. Herein, we report our single-institution 5-year experience treating patients with Kampo medicine for primary glossodynia that was refractory to conventional medicine. We found that 69.2% of patients reported a beneficial effect of Kampo medicine on glossodynia, and the average onset of improvement was 8.0 ± 7.7 weeks after starting Kampo treatment. The top two frequently used Kampo medicines for glossodynia were seinetsuhokito and mibakuekkito among high responders who showed a decrease of severity by 50% or more. The top four most overlapped herbs among effective Kampo medicines for glossodynia were Glycyrrhiza Root, Ginseng Root, Hoelen, and Atractylodes (lancea) Rhizome, which compose an essential Kampo prescription called shikunshito. Although more research is required to further clarify the effectiveness of Kampo medicine, it has valid efficacy even in cases of glossodynia that remain incurable by conventional treatments.
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Schmidinger M. Understanding and managing toxicities of vascular endothelial growth factor (VEGF) inhibitors. EJC Suppl 2013; 11:172-91. [PMID: 26217127 PMCID: PMC4041401 DOI: 10.1016/j.ejcsup.2013.07.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Ukai K, Kimura H, Arao M, Aleksic B, Yamauchi A, Ishihara R, Iritani S, Kurita K, Ozaki N. Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region. Psychogeriatrics 2013; 13:99-102. [PMID: 23909967 DOI: 10.1111/j.1479-8301.2012.00430.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 05/30/2012] [Accepted: 08/09/2012] [Indexed: 01/30/2023]
Abstract
Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM-IV. The patient was a 71-year-old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become 'limp and floppy' and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.
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Affiliation(s)
- Katsuyuki Ukai
- Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Japan.
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Napeñas JJ, Zakrzewska JM. Diagnosis and management of trigeminal neuropathic pains. Pain Manag 2011; 1:353-65. [DOI: 10.2217/pmt.11.35] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Trigeminal neuropathic pains have presented diagnostic and therapeutic challenges to providers. In addition, knowledge of pathophysiology, current classification systems, taxonomy and phenotyping of these conditions are incomplete. While trigeminal neuralgia is the most identifiable and studied, other conditions are being recognized and require distinct management approaches. Furthermore, other facial pain conditions such as atypical odontalgia and burning mouth syndrome are now considered to have neuropathic elements in their etiology. This article reviews current knowledge on the pathophysiology, diagnosis and management of neuropathic pain conditions involving the trigeminal nerve, to include: trigeminal neuralgia, trigeminal neuropathic pain (with traumatically induced neuralgia and atypical odontalgia) and burning mouth syndrome. Treatment modalities are reviewed based on current and best available evidence. Trigeminal neuralgia is managed with anticonvulsant drugs as the first line, with surgical options providing variable results. Trigeminal neuropathic pain is managed medically based on the guidelines for other neuropathic pain conditions. Burning mouth syndrome is also treated with a number of neuropathic medications, both topical and systemic. In all these conditions, patients need to be thoroughly educated about their condition, involved in its management, and be provided with supportive and adjunctive treatment resources.
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Affiliation(s)
- Joel J Napeñas
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Joanna M Zakrzewska
- Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, London, UK
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