title: Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbiities, treatment and outcome.
abstract: BACKGROUND
  Burning Mouth Syndrome (BMS) is a chronic pain condition characterized by persistent intraoral burning without related objective findings and unknown etiology that affects elderly females mostly. There is no satisfactory treatment for BMS. We aimed to observe the long-term efficacy of high velanfaxine doses combined with systemic and topical administered clonazepam in a particular subgroup of BMS patients who do not respond to current clinical management.
  
  
  RESULTS
  Eight (66.1 ± 6.2 years old females) out of 14 BMS patients fulfilled the inclusion criteria and were treated with venlafaxine (300 mg/d) and clonazepam (5 mg/d) for 35.4 ± 12.1 (mean ± SD) months. The average duration of the symptoms at baseline was 4.3 ± 1.4 years and the overall mean daily pain intensity score was 8.6 ± 1.3 (VAS); pain was in tongue and within the oral mucosa, accompanying by oral and facial dysesthesia. In five patients tasting was abnormal. All patients had positive history of concomitant primary headache. The average score of Hamilton Rating scale for Anxiety and Depression was 21 ± 4.2, and 26.1 ± 2.9, respectively. Previous ineffective treatments include anticonvulsants and anti-depressants. All patients responded (more than 50% decrease in VAS) after three months treatment (mean VAS 3.2 ± 2.2) with no remarkable adverse events.
  
  
  CONCLUSIONS
  BMS deserves bottomless psychiatric evaluation and management when current available treatments fail. Treatment with venlafaxine combined with topical and systemic clonazepam may be effective in refractory BMS cases but further investigation in a large-scale controlled study is needed to confirm these results.
authors.affiliation: Aeginition Hospital, National & Kapodistrian University of Athens, Athens, Greece. dimosmitsikostas@me.com.
authors.forename: Dimos D
authors.initials: DD
authors.lastname: Mitsikostas
authors.affiliation: Clinical Center of Nis, Clinic for Neurology, University of Nis, Nis, Serbia.
authors.forename: Srdjan
authors.initials: S
authors.lastname: Ljubisavljevic
authors.affiliation: Aeginition Hospital, National & Kapodistrian University of Athens, Athens, Greece.|Neurology Department, Athens Naval Hospital, Athens, Greece.
authors.forename: Christina I
authors.initials: CI
authors.lastname: Deligianni
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001007:Anxiety / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D002054:Burning Mouth Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D002908:Chronic Disease; D059350:Chronic Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D002998:Clonazepam / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D002998:Clonazepam
keywords: Burning mouth syndrome; Clinical picture; Clonazepam; Outcome; Treatment; Venlafaxine