Topical clonazepam in stomatodynia: a randomised placebo-controlled study

Abstract

Stomatodynia is characterised by a spontaneous burning pain in the oral mucosa without known cause or recognised treatment. The purpose of this double-blind, randomised, multicentre parallel group study was to evaluate the efficacy of the topical use of clonazepam. Forty-eight patients (4 men and 44 women, aged 65+/-2.1 years) were included, of whom 41 completed the study. The patients were instructed to suck a tablet of 1 mg of either clonazepam or placebo and hold their saliva near the pain sites in the mouth without swallowing for 3 min and then to spit. This protocol was repeated three times a day for 14 days. The intensity was evaluated by a 11-point numerical scale before the first administration and then after 14 days. Two weeks after the beginning of treatment, the decrease in pain scores was 2.4+/-0.6 and 0.6+/-0.4 in the clonazepam and placebo group, respectively (P = 0.014). Similar effects were obtained in an intent-to-treat analysis (P = 0.027). The blood concentration of clonazepam was similar whether it was measured 14 days after sucking a tablet three times a day or during the 5 h that followed sucking a single tablet (n = 5). It is hypothesised that clonazepam acts locally to disrupt the mechanism(s) underlying stomatodynia.

Evaluating the Etiologies of Burning Mouth Symptom in Patients of Shiraz Dental School from 2007 to 2015

“…This is in accordance with the populationbased study of the incidence of primary or idiopathic BMS by Kohorst et al which reports tongue as the most common site of burning and after that the burning of several sites in the oral cavity (8). There are reports of a few rare cases of only lips or palate burning sparing other anatomic 6 Iran Red Crescent Med J. 2017; 19(4):e42675.…”

“…Other symptoms which may accompany the glossodynia and BMS include oral dryness, paresthesia, and altered taste (4). Therefore, BMS is referred to as a particular form of neuropathic pain (5) with treatments relying on medications mostly used to treat neuropathic pain; medications such as clonazepam, capsaicin, and tricyclic antidepressants (6). Other non-pharmacological treatments suggested are cognitive behavioral therapy, cessation of smoking, biofeedback therapy, and acupuncture (5,7,8).…”

Burning Mouth Syndrome: A Review

“…The topical application of clonazepam (by sucking a tablet of 1 gm) two or three times a day for 14 days treatment period provided reduced burning in two thirds of the patients studied 53 . The most commonly used local anesthetic agent lidocaine has not been shown as an effective treatment due to their short duration of analgesic action.…”

“…The most commonly used local anesthetic agent lidocaine has not been shown as an effective treatment due to their short duration of analgesic action. Topical application of Aloe vera gel (0.5 ml three times a day) combined with tongue protector found to be effective 53 . Systemic drugs for BMS treatment include gabapentin, pregabalin, amitriptyline, nortriptyline, clonazepam, pramipexole and capsaicin.…”

Diagnosis and Management of Trigeminal Neuropathic Pains

“…Topical -suck for 3 min for 2 weeks Systemic -take at bedtime Shows some benefit Systemic -marked drowsiness, addictive [125] Capsaicin systemic (0.25% capsule three-times daily) One of the few long-term cohort studies for trigeminal neuralgia.…”