Current management strategies for the pain of elderly patients with burning mouth syndrome: a critical review

Abstract

Burning Mouth Syndrome (BMS), a chronic intraoral burning sensation or dysesthesia without clinically evident causes, is one of the most common medically unexplained oral symptoms/syndromes. Even though the clinical features of BMS have been astonishingly common and consistent throughout the world for hundreds of years, BMS remains an enigma and has evolved to more intractable condition. In fact, there is a large and growing number of elderly BMS patients for whom the disease is accompanied by systemic diseases, in addition to aging physical change, which makes the diagnosis and treatment of BMS more difficult. Because the biggest barrier preventing us from finding the core pathophysiology and best therapy for BMS seems to be its heterogeneity, this syndrome remains challenging for clinicians. In this review, we discuss currently hopeful management strategies, including central neuromodulators (Tricyclic Antidepressants - TCAs, Serotonin, and Norepinephrine Reuptake Inhibitors - SNRIs, Selective Serotonin Reuptake Inhibitors - SSRIs, Clonazepam) and solutions for applying non-pharmacology approaches. Moreover, we also emphasize the important role of patient education and anxiety management to improve the patients’ quality of life. A combination of optimized medication with a short-term supportive psychotherapeutic approach might be a useful solution.

<p>Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome</p>

“…Some patients need amitriptyline instead of SSRI and SNRI for their pain. 7 Nevertheless, no study has been conducted to investigate the therapeutic dose of amitriptyline for older BMS patients. Older patients become sensitive to medication probably because of the reduction in numbers of neurons and receptors, age-related change in blood-brain barrier.…”

“…The socioeconomic burden of chronic pain is huge for individuals and the society. 7 Safer and more effective treatments are needed for chronic pain to reduce this burden. One of the advantages of amitriptyline is its low cost.…”

“…6 Amitriptyline is one of the most commonly used drugs for treating BMS. 7 It is to be prescribed to older patients using the Screening Tool for Older Persons' Appropriate Prescriptions for Japanese (STOPP-J). 8 Generally, the required dose for analgesic treatment is lower than that required for depression treatment.…”

“…14 Some patients, especially older patients, do not benefit from using SSRIs and SNRIs and may even experience severe side effects due to drug-drug interaction. 7 Nevertheless, some older BMS patients need amitriptyline because of severe oral pain. For these reasons, it is imperative to identify a safe and effective therapeutic dose of amitriptyline for older BMS patients.…”

Patient Expectations of Visiting Department of Oral Medicine for Burning Mouth Syndrome: Relationship between Expectations and Clinical and Psychological Characteristics

“…Considering the natural course that a patient feels anxiety about a refractory pain of unknown etiology, it is not surprising that BMS, as a chronic pain, is frequently involved with stressful life events and psychological conditions including depression, anxiety, neuroticism and cancerphobia [2,6]. These intractable clinical problems that cannot be fully explained by biological processes are also a challenge for clinicians and thus, even little information on the patients might be a great help to clinicians.…”