Pain-relieving effects of clonazepam and amitriptyline in burning mouth syndrome: a retrospective study

Fénelon, Mathilde; Quinque, E.; Arrivé, Élise; Catros, Sylvain; Fricain, Jean-Christophe

doi:10.1016/j.ijom.2017.03.032

Cited by 29 publications

(23 citation statements)

References 32 publications

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“…2 These drugs include amitriptyline, clonazepam, SSRIs, and SNRIs. 10,14 SSRIs and SNRIs are featured by drug-drug interaction via cytochrome P450. The risk of adverse reactions is especially high in older patients with several comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…In most studies, 10-40 mg/day of amitriptyline is recommended for adult patients. 2,10 However, older patients need a lower dose of antidepressants than younger patients to achieve an effective blood level. 11 Nishtala et al 12 reported that the dose of antidepressants, especially tricyclic antidepressants (TCAs), for treating depression in older patients in care homes is less than the manufacturer's recommended minimum effective dose.…”

Section: Introductionmentioning

confidence: 99%

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

Suga

Takenoshita

Watanabe

et al. 2019

NDT

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Suga

Takenoshita

Watanabe

et al. 2019

NDT

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“…In the management of BMS, medications targeting the descending inhibitory pathway have also been frequently used. Clonazepam mainly enhances the serotonergic descending inhibition pathway [32,33], and TCAs inhibit both serotonin and norepinephrine reuptake [12]. It has been suggested that acting on either monoaminergic pathway alone is less effective for the production of analgesic effects compared to acting on both simultaneously [34][35][36].…”

Section: Discussionmentioning

confidence: 99%

“…Tricyclic antidepressants (TCAs), including nortriptyline and amitriptyline have also been used for the treatment of BMS in previous studies [11,12]. However, TCAs have an anticholinergic effect as a side effect which can lead to dry mouth that negatively affects BMS symptoms.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of Venlafaxine and Duloxetine in Refractory Burning Mouth Syndrome Patients

Kim

Kho

2019

JOMP

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Purpose: Venlafaxine and duloxetine have been shown to be effective in the treatment of neuropathic pain disorders. However, knowledge about the efficacy of venlafaxine and duloxetine on burning mouth syndrome (BMS) is still insufficient. The purpose of this study was to investigate the efficacy of venlafaxine and duloxetine on refractory BMS patients. Methods:Twelve refractory BMS patients who were prescribed venlafaxine or duloxetine were included in this study. These patients did not respond to previous administration of clonazepam, alpha-lipoic acid, gabapentin, and nortriptyline. All participants were the primary type of BMS patients who had no local and systemic factors related to the oral burning sensation. The intensities of oral symptoms following venlafaxine or duloxetine administration were compared with those before administration and at baseline.Results: Venlafaxine and duloxetine were prescribed to four and nine patients, respectively. One patient was prescribed both medications in turn. Among them, only two patients showed improvement of oral symptoms without side effects. In the other ten patients, symptoms failed to improve. Six of them reported that the drug was ineffective, and four of them stopped taking the medications on their own due to intolerable side effects, such as insomnia, constipation, drowsiness, dizziness, and xerostomia.Conclusions: Venlafaxine and duloxetine may only relieve oral symptoms in a minority of refractory BMS patients. Further large-scale studies are needed to determine the potential clinical factors that could predict the efficacy of venlafaxine and duloxetine.

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“…The same study showed mean VNS score of 4.4±2.0 with clonazepam and 4.1±2.7 with amitriptyline after 3 months of treatment. 27…”

Section: Correction Therapymentioning

confidence: 99%

Efficacy of Clonazepam and Nortriptyline in the Management of Burning Mouth Syndrome: A Comparative Study

Acharya¹,

Mishra²,

Nayak³

et al. 2019

jebmh

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BACKGROUNDBurning mouth syndrome (BMS) is a syndrome with intra oral burning sensation without clinical cause which occurs daily for more than 2 hours per day persisting for more than 3 months, which may be associated with taste alteration and oral dryness. The etiopathogenesis of BMS remains elusive and the most accepted theory suggests a neuropathic pain condition involved with neurotransmitter GABA in the gustatory system. Clonazepam-GABA agonist has been used in clinical practices for BMS. Nortriptyline, a TCA inhibits the reuptake of serotonin and norepinephrine into the synapse, thereby enhancing signalling via these neurotransmitters and thus used in neuropathic pain of BMS.METHODS 72 patients of VIMSAR ENT OPD complained of burning mouth sensation without any oral or general pathology and diagnosed as BMS from September 2017 to February 2019 were included in the study. 36 patients were prescribed clonazepam and other 36 patients were treated with nortriptyline. Clinical evaluation after 6 wks. and 3 months of treatment was done and pain evaluated with verbal numerical scale (VNS). RESULTSOut of 72 patients, 46 were males and the mean age of presentation was 66 years. At the time of presentation, the mean baseline VNS score for the group (n=36) treated with clonazepam was 7.1 ± 0.9 and for the group (n=36) treated with nortriptyline was 6.8 ± 1.2. After treatment, VNS scores were 4.7 ± 1.3 and 4.5 ± 0.9 respectively at 6 weeks (p=0.510) and 3.3 ± 1.3 and 2.5 ± 0.9 respectively at the end of 3 months (p=0.499). CONCLUSIONSNortriptyline is a better drug than Clonazepam for management of pain in patients with BMS. BACKGROUNDBurning mouth syndrome (BMS) is an idiopathic condition characterised by abnormal burning sensation of oral cavity involving buccal mucosa, tongue mucosa and soft palate without any evident pathological changes and sometimes associated with oral dryness and odynophagia. It usually occurs daily for few minutes to hours in a day and may persist for more than three months. Synonyms of BMS are stomatodynia, glossodynia, dry mouth, sore mouth or glossopyrosis. Its aetiology has still remained unclear. Patton et al. suggested that in a large percentage of patients, BMS probably involves interactions among local, systemic, and psychogenic factors. 1 It is a neuropathic pain which may be due to some local causes like chronic irritation of gustatory system which mediate the secretion of GABA, due to systemic causes or it may be due to psychological factors which mediate the secretion of serotonin. According to many recent literatures BMS has a neuropathic aetiology. 2-5 BMS aetiology could be due to local factors such as composition of saliva, mucosal blood flow, inflammation, and changes in cell morphology. [6][7][8][9] According to Lamey and Lewis BMS is of three different types. BMS type 1:Burning increasing throughout the day and reaching its peak in the evening. BMS type 2: Characterized by the complaint of continuous sensory disturbances.

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Pain-relieving effects of clonazepam and amitriptyline in burning mouth syndrome: a retrospective study

Cited by 29 publications

References 32 publications

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

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

Treatment Outcomes of Venlafaxine and Duloxetine in Refractory Burning Mouth Syndrome Patients

Efficacy of Clonazepam and Nortriptyline in the Management of Burning Mouth Syndrome: A Comparative Study

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