Background & Aims
Burning mouth syndrome (BMS) is a complex, idiopathic, and debilitating orofacial pain disorder defined as an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day for more than 3 months, without evident causative lesions on clinical examination and investigation, with or without somatosensory changes.
Available drugs to alleviate BMS have inconsistent and limited efficacy. Most notably, topical amitriptyline antinociceptive and antihyperalgesic actions involve a set of pathways (mainly through sodium and cation channels) thought to be important in BMS pathogenesis. Yet, there is no data relative to its use in BMS. Here, we investigate topical amitriptyline as a potential treatment.
Methods
In this cross-sectional study, BMS patients who were prescribed topical amitriptyline for eight weeks were identified from the ABCD cohort of the chronic oro facial pain department (COFPD) of the Pitié-Salpêtrière hospital in Paris, France, between January 1st, 2022, and December 31st, 2023. Eligibility criteria stemmed from ICHD-3, ICOP, and consensus definitions. The primary outcome measure was mean daily pain intensity (on a 0-10 scale); secondary outcomes included adverse events (AE). Data are mean±SD.
Results
Among the 39 patients identified, a total of 10 fulfilling the eligibility criteria were included and analyzed. All patients were females (63.9±8.7 years old), mainly anxious (11.67±5.89, HAD-A), of which 90% were menopausal. Mean pain duration was 24.2±20.1 months. Mean daily pain was 7.60±2.17 at baseline, 4.40±2.46 after treatment, with a mean reduction of 3.20±2.74 (P=0.016). Half of the patients experienced a reduction in pain by at least 50% (P=0.031). Several mild AEs such as drowsiness or dry mouth were reported.
Conclusions
To our knowledge, this cross-sectional study is the first to investigate topical amitriptyline as a potential treatment in patients with burning mouth syndrome. Overall, mean pain intensity (i.e., the primary outcome) was reduced by forty percent after eight weeks, with a few mild AEs reported (i.e., a secondary outcome). Topical amitriptyline may be a safe and potent candidate in the treatment of burning mouth syndrome; a hypothesis to be tested in further controlled trials.
References
1. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020; 40: 129–221.
2. Jääskeläinen SK, Woda A. Burning mouth syndrome. Cephalalgia 2017; 37: 627–647.
3. Tan HL, Smith JG, Hoffmann J, et al. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia 2022; 42: 128–161.
4. Genevois A-L, Ruel J, Penalba V, et al. Analgesic Effects of Topical Amitriptyline in Patients With Chemotherapy-Induced Peripheral Neuropathy: Mechanistic Insights From Studies in Mice. The Journal of Pain 2021; 22: 440–453.
5. Rossignol J, Cozzi B, Liebaert F, et al. High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies. Support Care Cancer 2019; 27: 3053–3059.
6. Domaneschi C, Carvalho VJG, Marotta BM, et al. Voltage-gated sodium channels gene expression in Burning Mouth Syndrome: a case-control study. Braz oral res 2023; 37: e005.
7. Yilmaz Z, Renton T, Yiangou Y, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. Journal of Clinical Neuroscience 2007; 14: 864–871.
8. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38: 1–211.
9. Chmieliauskaite M, Stelson EA, Epstein JB, et al. Consensus agreement to rename burning mouth syndrome and improve International Classification of Diseases-11 disease criteria: an international Delphi study. Pain 2021; 162: 2548–2557.
10. Farag AM, Albuquerque R, Ariyawardana A, et al. World Workshop in Oral Medicine VII: Reporting of IMMPACT?recommended outcome domains in randomized controlled trials of burning mouth syndrome: A systematic review. Oral Diseases 2019; 25: 122–140.
11. Gremeau-Richard C, Woda A, Navez ML, et al. Topical clonazepam in stomatodynia: a randomised placebo-controlled study. Pain 2004; 108: 51–57.
12. Colvin AC, Wang C-F, Soens MA, et al. Prolonged Cutaneous Analgesia With Transdermal Application of Amitriptyline and Capsaicin: Regional Anesthesia and Pain Medicine 2011; 36: 236–240.
Presenting Author
Ashley Lebel
Poster Authors
Ashley Lebel
DDS, MSc
Chronic Oro Facial Pain Department, Pitié-Salpêtrière Hospital, Paris, France
Lead Author
Yves Boucher (DDS
PhD)
Chronic Oro Facial Pain Department, Pitié-Salpêtrière Hospital, Paris, France
Lead Author
Dylan Da Silva Vieira (DDS)
Chronic Oro Facial Pain Department, Pitié-Salpêtrière Hospital, Paris, France
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain