Clinical Characteristics, Treatment Effectiveness, and Predictors of Response to Pharmacotherapeutic Interventions in Burning Mouth Syndrome: A Retrospective Analysis

Aims: To identify the clinical characteristics of patients with primary and secondary burning mouth syndrome (BMS), to assess the effectiveness of pharmacotherapy in treating BMS, and to determine the clinical variables that may predict significant relief of clinical symptoms. Methods: A retrospective chart review of patients who underwent clinical management for BMS in the Massachusetts General Hospital between January 2011 and December 2016 was carried out. Information regarding demographics, diagnostics, and therapeutic characteristics was extracted and analyzed. Results: Of 112 BMS patients, 77 had primary BMS. Patients with primary and secondary BMS had similar clinical characteristics except when it came to the presence of at least one symptom of sensory discrepancy, which was more prevalent in primary BMS. Following pharmacologic intervention, 46.8% of the patients with primary BMS experienced significant relief in symptoms, and this therapy was associated with a lower level of pain, an onset of symptoms of less than 1 year, hyperlipidemia, absence of depression disorder, and nonconcurrent use of other neuropathic medications. In contrast, only 31.4% of patients with secondary BMS experienced significant relief in symptoms, and this was associated with the presence of anxiety disorder. Stepwise forward conditional logistic regression analysis suggested that nonconcurrent use of neuropathic medications was a predictor for significant relief of symptoms in patients with primary BMS. Likewise, the model suggested that presence of anxiety disorder was a predictor in patients with secondary BMS. Conclusion: The prevalence of an associated sensory discrepancy was higher in primary BMS. Pharmacologic intervention provided significant relief for approximately half of the patients with primary BMS and nearly one-third of the patients with secondary BMS. Concurrent use of neuropathic medications was a negative predictor, and presence of anxiety disorder a positive predictor, of therapeutic response among patients with primary BMS and secondary BMS, respectively. Keywords: burning mouth syndrome, facial pain, neuropathic pain, pain