Souvagini Acharya1, Himanshu Mishra2, Rashmita Nayak3, Nirupama Pati4
BACKGROUND Burning mouth syndrome (BMS) is a syndrome with intra oral burning sensation without clinical cause which occurs daily for more than 2 hours per day persisting for more than 3 months, which may be associated with taste alteration and oral dryness. The etiopathogenesis of BMS remains elusive and the most accepted theory suggests a neuropathic pain condition involved with neurotransmitter GABA in the gustatory system. Clonazepam-GABA agonist has been used in clinical practices for BMS. Nortriptyline, a TCA inhibits the reuptake of serotonin and norepinephrine into the synapse, thereby enhancing signalling via these neurotransmitters and thus used in neuropathic pain of BMS. METHODS 72 patients of VIMSAR ENT OPD complained of burning mouth sensation without any oral or general pathology and diagnosed as BMS from September 2017 to February 2019 were included in the study. 36 patients were prescribed clonazepam and other 36 patients were treated with nortriptyline. Clinical evaluation after 6 wks. and 3 months of treatment was done and pain evaluated with verbal numerical scale (VNS). RESULTS Out of 72 patients, 46 were males and the mean age of presentation was 66 years. At the time of presentation, the mean baseline VNS score for the group (n=36) treated with clonazepam was 7.1 ± 0.9 and for the group (n=36) treated with nortriptyline was 6.8 ± 1.2. After treatment, VNS scores were 4.7 ± 1.3 and 4.5 ± 0.9 respectively at 6 weeks (p=0.510) and 3.3 ± 1.3 and 2.5 ± 0.9 respectively at the end of 3 months (p=0.499). CONCLUSIONS Nortriptyline is a better drug than Clonazepam for management of pain in patients with BMS.
