title: The dubious effect of milnacipran for the treatment of burning mouth syndrome.
abstract: OBJECTIVE
  Burning mouth syndrome (BMS) is a condition accompanied by oral burning symptoms, including glossal pain (glossodynia) without a detectable cause. Although BMS is a chronic-pain syndrome, only one self-controlled pilot study and some case reports have reported that milnacipran is effective for the treatment of chronic pain, including that caused by BMS. However, these papers assessed only pain, and the dosage of prescribed milnacipran varied from 30 to 150 mg/d in each patient. In this study, the dosage of prescribed milnacipran was set at 60 mg/d for 12 weeks for all patients, and depression and quality of life (QOL) were assessed in addition to pain.
  
  
  METHODS
  Twelve patients with glossodynia participated in this study. Milnacipran was initiated at a dosage of 15 mg/d and then raised gradually to 60 mg/d after 4 weeks of treatment; this dose was continued until the end of the study (total of 12 weeks). The evaluation included the Hamilton Rating Scale for Depression, the Visual Analog Scale score for pain evaluation, the General Oral Health Assessment Index for oral-related QOL evaluation, and the Medical Outcomes Study's 36-Item Short-Form Health Survey (SF-36) for whole QOL evaluation.
  
  
  RESULTS
  The Hamilton Rating Scale for Depression score decreased significantly after treatment with a 60-mg/d dosage of milnacipran for 12 weeks. However, the Visual Analog Scale pain, General Oral Health Assessment Index, and SF-36 scores did not change.
  
  
  CONCLUSIONS
  A randomized, double-blind, placebo-controlled multi-institution trial of milnacipran will be essential to determine its effectiveness for the treatment of BMS.
authors: Division of Psychosomatic and Oral Medicine, Tohoku Fukushi University, Sendai, Japan. k-s@umin.ac.jp
authors: Koreaki
authors: K
authors: Sugimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002054:Burning Mouth Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D015897:Comorbidity; D003521:Cyclopropanes / Q000008:administration & dosage / Q000627:therapeutic use*; D003863:Depression / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D005260:Female; D005926:Glossalgia / Q000209:etiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D000078764:Milnacipran; D014179:Neurotransmitter Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D009638:Norepinephrine / Q000037:antagonists & inhibitors / Q000502:physiology; D010147:Pain Measurement; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
chemical_list: D003521:Cyclopropanes; D000078764:Milnacipran; D014179:Neurotransmitter Uptake Inhibitors; D009638:Norepinephrine; D017367:Selective Serotonin Reuptake Inhibitors