Suicidal behavior in a patient with burning mouth syndrome

Analysis of pain prognosis, medication efficacy, treatment willingness and influencing factors in patients with burning mouth syndrome: a cross-sectional survey

OBJECTIVE

To explore the pain prognosis, medication efficacy and treatment willingness of patients with burning mouth syndrome (BMS) and to identify the factors influencing the pain prognosis, medication efficacy and treatment willingness of patients with BMS.

METHODS

Medical records of patients who were clinically diagnosed with BMS and who complained of oral mucosal pain at the Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, were retrospectively collected from January 2019 to April 2022. Telephone follow-ups were conducted in August 2024 to investigate the patients' pain prognosis, medication efficacy, willingness for treatment and related treatment information.

RESULTS

Among the 192 patients, only 31.77% (61/192) reported complete elimination of pain; 37.50% (72/192) reported that the pain still existed but had improved, and 30.73% (59/192) reported no improvement at all. A total of 31.25% (60/192), 34.90% (67/192), and 32.81% (63/192) of the BMS patients evaluated medication efficacy as significantly effective, effective, or ineffective, respectively. Among the 131 patients who still had pain symptoms, 38.17% (50/131) intended to continue treatment. Logistic regression revealed that patients who were older (P = 0.023), who had visited multiple hospitals for treatment (P = 0.001), who were afraid of cancer (P = 0.011) and who were prone to anxiety or depression (P < 0.001) had poorer pain improvement. Patients who had visited multiple hospitals (P < 0.001) and those who were prone to anxiety or depression (P < 0.001) had significantly lower evaluations of medication efficacy. Males (P = 0.041) and those who had visited multiple hospitals (P < 0.001) were more willing to continue treatment.

CONCLUSION

The prognosis for most BMS patients tends to be relatively poor. Age, anxiety or depression, and fear of cancer may affect the pain prognosis of patients with BMS, whereas psychological factors may also impact the efficacy of medication.

Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbiities, treatment and outcome

BACKGROUND

Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by persistent intraoral burning without related objective findings and unknown etiology that affects elderly females mostly. There is no satisfactory treatment for BMS. We aimed to observe the long-term efficacy of high velanfaxine doses combined with systemic and topical administered clonazepam in a particular subgroup of BMS patients who do not respond to current clinical management.

RESULTS

Eight (66.1 ± 6.2 years old females) out of 14 BMS patients fulfilled the inclusion criteria and were treated with venlafaxine (300 mg/d) and clonazepam (5 mg/d) for 35.4 ± 12.1 (mean ± SD) months. The average duration of the symptoms at baseline was 4.3 ± 1.4 years and the overall mean daily pain intensity score was 8.6 ± 1.3 (VAS); pain was in tongue and within the oral mucosa, accompanying by oral and facial dysesthesia. In five patients tasting was abnormal. All patients had positive history of concomitant primary headache. The average score of Hamilton Rating scale for Anxiety and Depression was 21 ± 4.2, and 26.1 ± 2.9, respectively. Previous ineffective treatments include anticonvulsants and anti-depressants. All patients responded (more than 50% decrease in VAS) after three months treatment (mean VAS 3.2 ± 2.2) with no remarkable adverse events.

CONCLUSION

BMS deserves bottomless psychiatric evaluation and management when current available treatments fail. Treatment with venlafaxine combined with topical and systemic clonazepam may be effective in refractory BMS cases but further investigation in a large-scale controlled study is needed to confirm these results.