title: Effect of lingual nerve block on burning mouth syndrome (stomatodynia): a randomized crossover trial.
abstract: Burning mouth syndrome (stomatodynia) is associated with changes of a neuropathic nature the main location of which, peripheral or central, remains unknown. A randomised, double-blind crossover design was used to investigate the effects of lingual nerve block on spontaneous burning pain and a possible correlation with the effects of topical clonazepam, the patient's response to a psychological questionnaire, and the taste and heat thresholds. The spontaneous burning was measured with a visual analogue scale (VAS) just before and 15 min after injection. The decreases in VAS score after lidocaine or saline injection were not significantly different (2.7+/-3.9 and 2.0+/-2.6, respectively; n=20). However, two groups of patients could be identified: in a "peripheral group" (n=10) the VAS decrease due to lingual nerve injection was 4.3+/-3.1cm after lidocaine and 0.9+/-0.3 cm after saline (p=0.02). In a "central group" (n=7), there were an increase in pain intensity score (-0.8+/-2.6 cm) after lidocaine and a decrease (1.5+/-3.0 cm) after saline (p=0.15). An increase in the hospital anxiety and depression (HAD) score and a decreased taste sensitivity and heat pain threshold of painful oral area were seen in patients compared with age-and-sex-matched controls (p<0.05). Topical clonazepam treatment tended to be more effective (p=0.07) and HAD score lower (p<0.03) in the peripheral than in the central group. These results suggest that the neuropathic disorder associated with stomatodynia may be predominantly peripheral, central or mixed depending on the individual. Topical application of clonazepam and HAD may serve as indicators of which mechanism is dominating.
authors.affiliation: EA 3847, Faculté de Chirurgie Dentaire, Université d'Auvergne, 63000 Clermont-Ferrand, France Inserm U 929, Clermont-Ferrand, France Centre de Pharmacologie Clinique, CHU, Clermont-Ferrand, France Département d'Information Médicale, CHU, Clermont-Ferrand, France CHU, Clermont-Ferrand, Hôtel-Dieu, F-63001 Clermont-Ferrand, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Grémeau-Richard
authors.forename: Claude
authors.initials: C
authors.lastname: Dubray
authors.forename: Bruno
authors.initials: B
authors.lastname: Aublet-Cuvelier
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ughetto
authors.forename: Alain
authors.initials: A
authors.lastname: Woda
mesh_terms: D000927:Anticonvulsants / Q000008:administration & dosage; D002054:Burning Mouth Syndrome / Q000175:diagnosis* / Q000188:drug therapy*; D002998:Clonazepam / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008036:Lingual Nerve / Q000187:drug effects*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D002998:Clonazepam