The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

Watanabe, Motoko; Takao, Chihiro; Liu, Zhenyan; Nayanar, G.K.; Suga, Takayuki; Hong, Chaoli; Tu, Trang Thi Huyen; Yoshikawa, Tatsuya; Takenoshita, Miho; Motomura, Haruhiko; Nagamine, Takahiko; Toyofuku, Akira

doi:10.3389/fpain.2022.809207

Cited by 9 publications

(5 citation statements)

References 14 publications

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“…The salience network is modulated by dopamine 24 . Dopamine partial agonists have been shown to be as effective as amitriptyline in the treatment of BMS 25 . Patients with BMS exacerbated by serotonin augmentation may merit a trial of pharmacotherapy to dopaminergic systems such as a dopamine partial agonist 26,27 .…”

Section: Discussionmentioning

confidence: 99%

“…24 Dopamine partial agonists have been shown to be as effective as amitriptyline in the treatment of BMS. 25 Patients with BMS exacerbated by serotonin augmentation may merit a trial of pharmacotherapy to dopaminergic systems such as a dopamine partial agonist. 26,27 For this reason, early determination of amitriptyline nonresponse is important.…”

Section: Speculation On the Mechanism By Which Amitriptyline Enhances...mentioning

confidence: 99%

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

Nagamine,

Watanabe,

Toyofuku

2024

Clin Neuropharm

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Speculation On the Mechanism By Which Amitriptyline Enhances...mentioning

confidence: 99%

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

Nagamine,

Watanabe,

Toyofuku

2024

Clin Neuropharm

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“…APZ is a partial agonist of dopamine D2 receptors; it is also called a dopamine system stabilizer as it suppresses excessive dopamine activity, or activates it when dopamine is underactive 15 . APZ is thought to improve ADHD 16 , chronic pain 41 , and IOP 42 , 43 . In cases where APZ administration did not result in sufficient improvement or with intolerable adverse effects, the patient underwent combination therapy with clonidine, a noradrenergic alpha 2 receptor agonist that is effective for ADHD 15 , or switched to clonidine.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

Kasahara

Takahashi

Matsudaira

et al. 2023

Sci Rep

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Attention-deficit/hyperactivity disorder (ADHD) has been reported to be associated with primary chronic pain syndromes, such as fibromyalgia, migraine, and chronic low back pain. Although idiopathic orofacial pain (IOP) is classified as burning mouth syndrome or persistent idiopathic facial or dentoalveolar pain and as a primary chronic pain, the association between IOP and ADHD has not been investigated. This retrospective cohort study investigated the severity of ADHD symptoms measured using the ADHD scale and the effects of treatment using ADHD drugs and the dopamine system stabilizer aripiprazole. The participants were 25 consecutive patients with refractory IOP referred to a psychiatrist and diagnosed with coexisting ADHD according to the Diagnostic and Statistical Manual of Mental Disorders-5. The ADHD scale scores were higher in patients with intractable IOP than those in the general population. Pharmacotherapy used in this study led to clinically significant improvements in pain, anxiety/depression, and pain catastrophizing. Intractable IOP and ADHD were shown to be associated. In the future, screening and pharmacotherapy for ADHD should be considered in the treatment of intractable IOP.

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“…Retrospective long-term treatment outcomes may be a more critical option (27,28). Complete remission of BMS or AO is not so frequent in these medication therapies; however, it is not always impossible if adequate psychosocial intervention is available.…”

Section: Lack Of Long-term Prognosismentioning

confidence: 99%

Reappraising the psychosomatic approach in the study of “chronic orofacial pain”: looking for the essential nature of these intractable conditions

Toyofuku,

Matsuoka,

Abiko

2024

Front. Pain Res.

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As burning mouth syndrome (BMS) and atypical odontalgia (AO) continue to remain complex in terms of pathophysiology and lack explicit treatment protocol, clinicians are left searching for appropriate solutions. Oversimplification solves nothing about what bothers us in clinical situations with BMS or AO. It is important to treat a complicated phenomenon as complex. We should keep careful observations and fact-finding based on a pragmatic approach toward drug selection and prescription with regular follow-up. We also need to assess the long-term prognosis of treatment with a meticulous selection of sample size and characteristics. Further investigation of BMS and AO from a psychosomatic perspective has the potential to provide new insight into the interface between brain function and “chronic orofacial pain.”

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The Effectiveness and Adverse Events of Amitriptyline and Aripiprazole in Very Elderly Patients With BMS

Cited by 9 publications

References 14 publications

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

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

Diagnosis and treatment of intractable idiopathic orofacial pain with attention-deficit/hyperactivity disorder

Reappraising the psychosomatic approach in the study of “chronic orofacial pain”: looking for the essential nature of these intractable conditions

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