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Porporatti AL, Schroder ÂGD, Lebel A, Moreau N, Misery L, Alajbeg I, Braud A, Boucher Y. Is burning mouth syndrome associated with stress? A meta-analysis. J Oral Rehabil 2023; 50:1279-1315. [PMID: 37332081 DOI: 10.1111/joor.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/04/2023] [Accepted: 06/10/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Some studies have shown burning mouth syndrome (BMS) as comorbid psychosocial and psychiatric disorders, and as well, pointed at stress as a major risk factor. OBJECTIVE The aim of this meta-analysis was to answer the following question: 'Is there an association between BMS and stress, compared to healthy controls?' METHODS Two reviewers searched for the effect of stress in BMS and published on five main databases and three from the grey literature. Various questionnaires and biomarkers were analysed. Of the 2489 selected articles, 30 met the inclusion criteria. Studies englobed questionnaires, such as Perceived Stress Questionnaire, Lipp Stress Symptoms Inventory, Holmes-Rahe scale, Depression, Anxiety, and Stress Scale (DASS-21), Recent Experience Test; and various biomarkers, such as cortisol, opiorphin, IgA, α-amylase and interleukins. RESULTS In all studies with questionnaires, stress was significantly increased in the BMS group vs. control. Patients with BMS presented 25.73% higher cortisol levels, 28.17% higher IgA levels and 40.62% higher α-amylase levels than controls. Meta-analysis found that BMS subjects presented 3.01 nmoL/L [0.53; 5.50] higher cortisol levels, 84.35 kU/L [15.00; 153.71] higher α-amylase levels, 29.25 mg/mL [9.86; 48.64] higher IgA levels and 258.59 pg/mL [59.24; 457.94] higher IL-8 levels than control. No differences were found for opiorphin concentration in ng/mL [-0.96; 2.53]. For interleukins, no differences were founded for IL-1 β, IL-2, IL-4, IL-6, IL-8, IL-10 and TNF-α. CONCLUSION Based on the available evidence, this meta-analysis suggests more stress factors in questionnaire-based studies, and higher levels of cortisol, α-amylase, IgA and IL-8 biomarkers in BMS subjects than controls.
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Affiliation(s)
- André Luís Porporatti
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Ashley Lebel
- Laboratoire de Neurobiologie OroFaciale, Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nathan Moreau
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité and Hôpital Bretonneau (AP-HP), Paris, France
| | | | | | - Adeline Braud
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
| | - Yves Boucher
- Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, France and GHPS Assistance Publique Hôpitaux de Paris, Paris, France
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Farag AM, Kuten-Shorrer M, Natto Z, Ariyawardana A, Mejia LM, Albuquerque R, Carey B, Chmieliauskaite M, Miller CS, Ingram M, Nasri-Heir C, Sardella A, Carlson CR, Klasser GD. WWOM VII: Effectiveness of systemic pharmacotherapeutic interventions in the management of BMS: A systematic review and meta-analysis. Oral Dis 2023; 29:343-368. [PMID: 33713052 DOI: 10.1111/odi.13817] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the effectiveness of systemic pharmacotherapeutic interventions compared to placebo in burning mouth syndrome (BMS) randomized controlled trials (RCTs) based on the core outcome domains recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). METHODS A systematic literature review of RCTs, concerning systemic pharmacotherapeutic interventions for BMS, published from January 1994 through October 2019, and meta-analysis was performed. RESULTS Fourteen RCTs (n = 734 participants) were included. Of those, nine were eligible for the quantitative assessment due to the availability/homogeneity of data for at least one of the IMMPACT domains. Pain intensity was the only domain reported in all RCTs. Weighted mean changes in pain intensity, based on visual analogue scale (ΔVAS), were reported in three RCTs at 6 ± 2 weeks and only one RCT at 10+ weeks follow-ups. Quantitative assessment, based on ΔVAS, yielded very low evidence for the effectiveness of alpha-lipoic acid and clonazepam, low evidence for effectiveness of trazodone and melatonin, and moderate evidence for herbal compounds. CONCLUSIONS Based on the RCTs studied, variable levels of evidence exist that suggest that select pharmacological interventions are associated with improved symptoms. However, the underreporting of IMMPACT domains in BMS RCTs restricts the multidimensional assessment of systemic interventions outcomes. Standardized outcome measures need to be applied to future RCTs to improve understanding of intervention outcomes.
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Affiliation(s)
- Arwa M Farag
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia.,Division of Oral Medicine, Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA
| | - Michal Kuten-Shorrer
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA.,Department of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Zuhair Natto
- Department of Dental Public Health, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia.,Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Australia.,Metro South Oral Health, Brisbane, Australia
| | - Lina M Mejia
- Department of Oral Medicine and Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Rui Albuquerque
- Oral Medicine Department, Guy's and St Thomas Hospital NHS Foundation Trust, King's college London, London, UK
| | - Barbara Carey
- Oral Medicine Department, Guy's and St Thomas Hospital NHS Foundation Trust, King's college London, London, UK
| | - Milda Chmieliauskaite
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Mark Ingram
- Medical Center Library, University of Kentucky Libraries, Lexington, KY, USA
| | - Cibele Nasri-Heir
- Center for Temporomandibular Disorders and Orofacial Pain, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, The State University of New Jersey, Newark, NJ, USA
| | - Andrea Sardella
- Unit of Oral Medicine, Oral Pathology and Gerodontology, Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Charles R Carlson
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Gary D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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3
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Sangalli L, Miller CS. Low Dose Naltrexone for Treatment of Burning Mouth Syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 135:e83-e88. [PMID: 35851249 DOI: 10.1016/j.oooo.2022.04.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The International Classification of Disease defines burning mouth syndrome (BMS) as a chronic intraoral burning sensation, with no identifiable local or systemic cause. Since current management is often unsatisfactory, the aim of this report is to describe a new treatment modality (i.e., low-dose naltrexone [LDN]). STUDY DESIGN A 62-year-old woman presented with the complaint of burning on the tongue of 3 years' duration. Existing comorbidities were fibromyalgia, irritable bowel syndrome, headache, and interstitial cystitis. Her reported pain intensity ranged from 2/10 (morning) to 8/10 (evening) on a numeric rating scale. With the diagnosis of BMS and hyposalivation, and in light of her current clonazepam use and fibromyalgia, a dry mouth protocol and LDN (3 mg) were prescribed. RESULTS After 1 month, her pain intensity decreased by 50%, with no pain upon awakening. After 2 months, the widespread pain associated with her chronic morbidities also reduced by 50%, and her headache disappeared. After adjusting LDN dose to 4.5 mg, the patient was stable at 6 months, with 50% reduction of widespread pain and 2/10 BMS pain, and no reported side effects. CONCLUSIONS These preliminary results suggest that LDN may be a feasible and effective treatment for BMS, especially in patients' refractory to traditional treatment.
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Hanna R, Bensadoun RJ, Beken SV, Burton P, Carroll J, Benedicenti S. Outpatient Oral Neuropathic Pain Management with Photobiomodulation Therapy: A Prospective Analgesic Pharmacotherapy-Paralleled Feasibility Trial. Antioxidants (Basel) 2022; 11:533. [PMID: 35326183 PMCID: PMC8944471 DOI: 10.3390/antiox11030533] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Abstract
Neuropathic pain (NP) can be challenging to treat effectively as analgesic pharmacotherapy (MED) can reduce pain, but the majority of patients do not experience complete pain relief. Our pilot approach is to assess the feasibility and efficacy of an evidence-based photobiomodulation (PBM) intervention protocol. This would be as an alternative to paralleled standard analgesic MED for modulating NP intensity-related physical function and quality of life (QoL) prospectively in a mixed neurological primary burning mouth syndrome and oral iatrogenic neuropathy study population (n = 28). The study group assignments and outcome evaluation strategy/location depended on the individual patient preferences and convenience rather than on randomisation. Our prospective parallel study aimed to evaluate the possible pre/post-benefit of PBM and to allow for a first qualitative comparison with MED, various patient-reported outcome measures (PROMs) based on Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT-II) were used for up to a nine-month follow-up period in both intervention groups (PBM and MED). The PBM protocol applied to the PBM group was as follows: λ810 nm, 200 mW, 0.088 cm2, 30 s/point, 9 trigger and affected points, twice a week for five consecutive weeks, whereas the MED protocol followed the National Institute of Clinical Excellence (NICE) guidelines. Our results showed that despite the severe and persistent nature of the symptoms of 57.50 ± 47.93 months at baseline in the PBM group, a notably rapid reduction in PISmax on VAS from 7.6 at baseline (T0) to 3.9 at one-month post-treatment (T3) could be achieved. On the other hand, mean PISmax was only reduced from 8.2 at baseline to 6.8 at T3 in the MED group. Our positive PBM findings furthermore support more patients' benefits in improving QoL and functional activities, which were considerably impaired by NP such as: eating, drinking and tasting, whereas the analgesic medication regimens did not. No adverse events were observed in both groups. To the best knowledge of the authors, our study is the first to investigate PBM efficacy as a monotherapy compared to the gold standard analgesic pharmacotherapy. Our positive data proves statistically significant improvements in patient self-reported NP, functionality, psychological profile and QoL at mid- and end-treatment, as well as throughout the follow-up time points (one, three, six and nine months) and sustained up to nine months in the PBM group, compared to the MED group. Our study, for the first time, proves the efficacy and safety of PBM as a potent analgesic in oral NP and as a valid alternative to the gold standard pharmacotherapy approach. Furthermore, we observed long-term pain relief and functional benefits that indicate that PBM modulates NP pathology in a pro-regenerative manner, presumably via antioxidant mechanisms.
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Affiliation(s)
- Reem Hanna
- Department of Oral Surgery, Dental Institute, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy;
| | - René Jean Bensadoun
- Department of Radiology Oncology, Centre De Haute Energie, 10 Boulevard Pasteur, 06000 Nice, France;
| | - Seppe Vander Beken
- Bredent Medical GmbH & Co., Gewerbegebiet Gartenäcker, Weißenhorner Str. 2, 89250 Senden, Germany;
| | - Patricia Burton
- Thor Photomedicine Ltd., Water Meadow, Chesham HP5 1LF, UK; (P.B.); (J.C.)
| | - James Carroll
- Thor Photomedicine Ltd., Water Meadow, Chesham HP5 1LF, UK; (P.B.); (J.C.)
| | - Stefano Benedicenti
- Department of Surgical Sciences and Integrated Diagnostics, Laser Therapy Centre, University of Genoa, Viale Benedetto XV,6, 16132 Genoa, Italy;
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HÄGGMAN-HENRIKSON BIRGITTA, LOBBEZOO FRANK, DURHAM JUSTIN, PECK CHRISTOPHER, LIST THOMAS. THE VOICE OF THE PATIENT IN OROFACIAL PAIN MANAGEMENT. J Evid Based Dent Pract 2022; 22:101648. [DOI: 10.1016/j.jebdp.2021.101648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 12/30/2022]
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Langbroek GB, Wolkerstorfer A, Horbach SER, Spuls PI, Kelly KM, Robertson SJ, van Raath MI, Al-Niaimi F, Kono T, Boixeda P, Laubach HJ, Badawi AM, Troilius Rubin A, Haedersdal M, Manuskiatti W, van der Horst CMAM, Ubbink DT. Development of a core outcome domain set for clinical research on capillary malformations (the COSCAM project). J Eur Acad Dermatol Venereol 2021; 35:1888-1895. [PMID: 34014582 PMCID: PMC8453952 DOI: 10.1111/jdv.17376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/19/2023]
Abstract
Background Due to a large variety in treatment outcomes reported in therapeutic trials and lacking patient‐relevant outcomes, it is hard to adequately compare and improve current therapies for patients with capillary malformations (CMs). The Core Outcome Set for Capillary Malformations (COSCAM) project aims to develop a core outcome set (COS) for use in future CM trials, in which we will first develop a core outcome (sub)domain set (CDS). Here, we describe the methods for the development of a CDS and present the results of the first development stage. Methods The COSCAM project is carried out according to the recommendations of the Cochrane Skin Core OUtcomes Set INitiative (CS‐COUSIN) and the Core Outcome Measures in Effectiveness Trials (COMET) initiative. During the first stage, we identified all potentially relevant outcome subdomains based on a systematic review, two focus group sessions and input from patient representatives of Dutch patient organizations and the COSCAM‐founding group. In stage two, we will present the subdomains in a three‐round e‐Delphi study and online consensus meeting, in which CM patients, parents/caregivers and CM experts worldwide rate the importance of the proposed subdomains, hereby finalizing the core outcome (sub)domains of the CDS. Results A total of 67 potential outcome subdomains were included; sixteen were previously used in the literature, 20 were proposed by Dutch patients and their parents/caregivers (n = 13) in focus group sessions and 38 were suggested by the experts of the COSCAM‐founding group. Seven were excluded because of overlap. Conclusion The final CDS may serve as a minimum standard in future CM trials, thereby facilitating adequate comparison of treatment outcomes. After this CDS development, we will select appropriate outcome measurement instruments to measure the core outcome subdomains.
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Affiliation(s)
- G B Langbroek
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - S E R Horbach
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam University Medical Center UMC, Amsterdam Public Health, Immunity and Infections, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Kelly
- Department of Dermatology, University of California Irvine, Irvine, CA, USA
| | - S J Robertson
- Department of Dermatology and Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - M I van Raath
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - F Al-Niaimi
- Private Dermatological Practice, London, UK.,Department of Dermatology, University of Aalborg, Aalborg, Denmark
| | - T Kono
- Department of Plastic Surgery, Tokai University School of Medicine, Shimokasuya Isehara Kanagawa, Kanagawa, Japan
| | - P Boixeda
- Department of Dermatology, Hospital Ramon y Cajal, Madrid, Spain
| | - H J Laubach
- Department of Dermatology, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - A M Badawi
- Department of Dermatology, Szeged University, Szeged, Hungary.,Department of Medical Laser Applications, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - A Troilius Rubin
- Department of Dermatology, Skåne University Hospital, Malmö, Sweden
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Copenhagen NV, Denmark
| | - W Manuskiatti
- Department of Dermatology, Siriraj Skin Laser Center Department of Dermatology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - C M A M van der Horst
- Department of Plastic-, Reconstructive- and Hand Surgery, Amsterdam University Medical Center (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - D T Ubbink
- Department of Surgery, Amsterdam University Medical Center (UMC) Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Carey B, Farag AM, Nasri-Heir C, Klasser GD, Ariyawardana A, Chmieliauskaite M, Sardella A, Carlson CR, Miller CS, Mejia L, O'Neill FE, Albuquerque R. Correction to: IMMPACT-recommended outcome measures and tools of assessment in burning mouth syndrome RCTs: an international Delphi survey protocol. Trials 2021; 22:225. [PMID: 33752708 PMCID: PMC7983374 DOI: 10.1186/s13063-021-05183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Barbara Carey
- Oral Medicine Department, Guy's and St. Thomas Hospital NHS Foundation Trust, King's College London, London, UK
| | - Arwa M Farag
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, King AbdulAziz University, Jeddah, Saudi Arabia.,Division of Oral Medicine, Department of Diagnostic Sciences, Tufts School of Dental Medicine, Boston, MA, USA
| | - Cibele Nasri-Heir
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, The State University of New Jersey, Newark, NJ, USA
| | - Gary D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Anura Ariyawardana
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.,Metro South Oral Health, Brisbane, Queensland, Australia
| | - Milda Chmieliauskaite
- Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Andrea Sardella
- Department of Biomedical, Surgical and Dental Sciences, Unit of Oral Medicine, Oral Pathology and Gerodontology, University of Milan, Milan, Italy
| | - Charles R Carlson
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Craig S Miller
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, USA
| | - Lina Mejia
- College of Dental Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Francis E O'Neill
- Department of Oral Surgery, School of Dentistry, University of Liverpool, Liverpool, UK
| | - Ruy Albuquerque
- Oral Medicine Department, Guy's and St. Thomas Hospital NHS Foundation Trust, King's College London, London, UK. .,Department of Oral Medicine, Faculty of Dentistry, Oral Craniofacial Sciences, King's College London, Floor 22, Guy's Tower, London, SE1 9RT, UK.
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