title: Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region.
abstract: Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM-IV. The patient was a 71-year-old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become 'limp and floppy' and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.
authors.affiliation: Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Japan. ukai777@kamiiidahp.jp
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Ukai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kimura
authors.forename: Munetaka
authors.initials: M
authors.lastname: Arao
authors.forename: Branko
authors.initials: B
authors.lastname: Aleksic
authors.forename: Aya
authors.initials: A
authors.lastname: Yamauchi
authors.forename: Ryoko
authors.initials: R
authors.lastname: Ishihara
authors.forename: Shuji
authors.initials: S
authors.lastname: Iritani
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kurita
authors.forename: Norio
authors.initials: N
authors.lastname: Ozaki
mesh_terms: D002054:Burning Mouth Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D003521:Cyclopropanes / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005926:Glossalgia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D000078764:Milnacipran; D012563:Schizophrenia, Paranoid / Q000150:complications* / Q000188:drug therapy; D013001:Somatoform Disorders / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D003521:Cyclopropanes; D000078764:Milnacipran
keywords: burning mouth syndrome; glossodynia; milnacipran; oral cenesthopathy; pain disorder; somatic-type delusional disorder