Effectiveness of Pregabalin for Treatment of Burning Mouth Syndrome

The effective perospirone augmentation with clonazepam for treatment-resistant burning mouth syndrome: A case report

Burning mouth syndrome (BMS) is characterized by burning sensations in the oral region without corresponding abnormalities and is often accompanied by uncomfortable sensations. Herein, we present cases of BMS in which the remaining uncomfortable sensations improved with perospirone augmentation with clonazepam. Case 1: A 61-year-old man complained of a burning pain in his tongue, a sensation of dryness and discomfort as if his tongue was sticking to a palatal plate. With the diagnosis of BMS, psychopharmacotherapy was initiated with amitriptyline. At the dose of amitriptyline 50 mg, the pain lessened but uncomfortable sensations persisted. Further attempts to alleviate symptoms by combining aripiprazole with amitriptyline, aripiprazole with mirtazapine, or aripiprazole with clonazepam were limited; however, nearly all symptoms were relieved by a combination of perospirone 8.0 mg with clonazepam 1.5 mg. Case 2: A 51-year-old woman complained of a burning sensation along with oral dryness and crumb-like feeling on her tongue. She was diagnosed with BMS and began treatment with amitriptyline. Her burning sensation improved at the dose of 25 mg, but uncomfortable sensations persisted. Augmentation of amitriptyline with aripiprazole, aripiprazole either with valproate, mirtazapine, or clonazepam failed to produce a significant improvement. However, a regimen of perospirone 6.0 mg and clonazepam 1.5 mg relieved the crumb-like sensation and pain and culminated in a stabilized condition. The reported cases suggested that multiple approaches targeting the dopaminergic circuit in basal ganglia involving the serotoninergic and GABA systems, through the administration of perospirone with clonazepam is an effective adjunctive treatment for the remaining uncomfortable sensations in patients with BMS.

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.

QTc Shortening on Electrocardiogram With Amitriptyline May Indicate No Effect on Pain Relief in Burning Mouth Syndrome

OBJECTIVE

Burning mouth syndrome (BMS) is an intractable chronic pain disorder characterized by a burning sensation without organic abnormalities in the oral mucosa. Amitriptyline may be effective for BMS or, conversely, may exacerbate pain. QTc is necessary for monitoring psychotropic adverse effects, but it is not known if it is a predictor of efficacy for BMS. We investigated the efficacy of amitriptyline in BMS and its effect on QTc.

METHODS

Visual analog scale and electrocardiogram were examined before and 1 month after treatment in 51 consecutive patients diagnosed with BMS according to the International Classification of Headache Disorders, Third Edition (ICHD-3), criteria and treated with amitriptyline.

RESULTS

There were 26 amitriptyline responders and 25 nonresponders, with no differences in age, sex, and amitriptyline dosage. Amitriptyline responders showed little change in QTc, whereas nonresponders showed a trend toward significantly shorter QTc. Changes in visual analog scale correlated statistically significantly with changes in QTc (Spearman rank correlation coefficient: 0384; P = 0.0054). The degree of pain tended to worsen with QTc shortening.

CONCLUSION

Amitriptyline provides analgesia in about half of BMS patients, but some BMS patients have worse pain with amitriptyline. Not only do changes in the QTc detect amitriptyline adverse effects with prolongation, but also, conversely, its shortening predicts amitriptyline ineffectiveness.