Treatment Outcomes of Venlafaxine and Duloxetine in Refractory Burning Mouth Syndrome Patients

다국어 초록 (Multilingual Abstract)

Purpose: Venlafaxine and duloxetine have been shown to be effective in the treatment ofneuropathic pain disorders. However, knowledge about the efficacy of venlafaxine and duloxetineon burning mouth syndrome (BMS) is still insufficient. The purpose of this studywas to investigate the efficacy of venlafaxine and duloxetine on refractory BMS patients.
Methods: Twelve refractory BMS patients who were prescribed venlafaxine or duloxetinewere included in this study. These patients did not respond to previous administration ofclonazepam, alpha-lipoic acid, gabapentin, and nortriptyline. All participants were the primarytype of BMS patients who had no local and systemic factors related to the oral burningsensation. The intensities of oral symptoms following venlafaxine or duloxetine administrationwere compared with those before administration and at baseline.
Results: Venlafaxine and duloxetine were prescribed to four and nine patients, respectively.
One patient was prescribed both medications in turn. Among them, only two patientsshowed improvement of oral symptoms without side effects. In the other ten patients,symptoms failed to improve. Six of them reported that the drug was ineffective, and fourof them stopped taking the medications on their own due to intolerable side effects, such asinsomnia, constipation, drowsiness, dizziness, and xerostomia.
Conclusions: Venlafaxine and duloxetine may only relieve oral symptoms in a minority ofrefractory BMS patients. Further large-scale studies are needed to determine the potentialclinical factors that could predict the efficacy of venlafaxine and duloxetine.

참고문헌 (Reference)

1 Sindrup SH, "Venlafaxine versus imipramine in painful polyneuropathy: a randomized, controlled trial" 60 : 1284-1289, 2003

2 Scala A, "Update on burning mouth syndrome: overview and patient management" 14 : 275-291, 2003

3 Gillman PK, "Tricyclic antidepressant pharmacology and therapeutic drug interactions updated" 151 : 737-748, 2007

4 Aiyer R, "Treatment of neuropathic pain with venlafaxine: a systematic review" 18 : 1999-2012, 2017

5 Gremeau-Richard C, "Topical clonazepam in stomatodynia: a randomised placebo-controlled study" 108 : 51-57, 2004

6 Kwon M, "The role of descending inhibitory pathways on chronic pain modulation and clinical implications" 14 : 656-667, 2014

7 Mitsikostas DD, "Refractory burning mouth syndrome: clinical and paraclinical evaluation, comorbiities, treatment and outcome" 18 : 40-, 2017

8 Jääskeläinen SK, "Pathophysiology of primary burning mouth syndrome" 123 : 71-77, 2012

9 Fenelon M, "Painrelieving effects of clonazepam and amitriptyline in burning mouth syndrome: a retrospective study" 46 : 1505-1511, 2017

10 Argoff C, "Mechanisms of pain transmission and pharmacologic management" 27 : 2019-2031, 2011

11 Wong DT, "LY248686, a new inhibitor of serotonin and norepinephrine uptake" 8 : 23-33, 1993

12 Jääskeläinen SK, "Is burning mouth syndrome a neuropathic pain condition?" 159 : 610-613, 2018

13 Ito M, "Five patients with burning mouth syndrome in whom an antidepressant (serotonin-noradrenaline reuptake inhibitor) was not effective, but pregabalin markedly relieved pain" 38 : 158-161, 2015

14 Marchand F, "Evidence for a monoamine mediated, opioid-independent, antihyperalgesic effect of venlafaxine, a non-tricyclic antidepressant, in a neurogenic pain model in rats" 103 : 229-235, 2003

15 Rodríguez-de Rivera-Campillo E, "Evaluation of the response to treatment and clinical evolution in patients with burning mouth syndrome" 18 : e403-e410, 2013

16 Razazian N, "Evaluation of the efficacy and safety of pregabalin, venlafaxine, and carbamazepine in patients with painful diabetic peripheral neuropathy. A randomized, double-blind trial" 19 : 192-198, 2014

17 Amr YM, "Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain" 26 : 381-385, 2010

18 Trouvin AP, "Efficacy of venlafaxine in neuropathic pain: a narrative review of optimized treatment" 39 : 1104-1122, 2017

19 Iyengar S, "Efficacy of duloxetine, a potent and balanced serotoninnorepinephrine reuptake inhibitor in persistent pain models in rats" 311 : 576-584, 2004

20 Cui Y, "Efficacy evaluation of clonazepam for symptom remission in burning mouth syndrome: a metaanalysis" 22 : 503-511, 2016

21 Bellingham GA, "Duloxetine: a review of its pharmacology and use in chronic pain management" 35 : 294-303, 2010

22 Kim YD, "Duloxetine in the treatment of burning mouth syndrome refractory to conventional treatment: a case report" 42 : 879-883, 2014

23 Lunn MP, "Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia" (1) : CD007115-, 2014

24 Fishbain D, "Duloxetine for neuropathic pain based on recent clinical trials" 10 : 199-204, 2006

25 Mott AE, "Diagnosis and management of taste disorders and burning mouth syndrome" 37 : 33-71, 1993

26 Ossipov MH, "Descending pain modulation and chronification of pain" 8 : 143-151, 2014

27 Millan MJ, "Descending control of pain" 66 : 355-474, 2002

28 Kim MJ, "Comparison between burning mouth syndrome patients with and without psychological problems" 47 : 879-887, 2018

29 Bymaster FP, "Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors" 25 : 871-880, 2001

30 Amos K, "Combined topical and systemic clonazepam therapy for the management of burning mouth syndrome:a retrospective pilot study" 25 : 125-130, 2011

31 López-D’alessandro E, "Combination of alpha lipoic acid and gabapentin, its efficacy in the treatment of Burning Mouth Syndrome: a randomized, double-blind, placebo controlled trial" 16 : e635-e640, 2011

32 Albuquerque RJ, "Cerebral activation during thermal stimulation of patients who have burning mouth disorder: an fMRI study" 122 : 223-234, 2006

33 Liu YF, "Burning mouth syndrome:a systematic review of treatments" 24 : 325-344, 2018

34 Sardella A, "Burning mouth syndrome: a retrospective study investigating spontaneous remission and response to treatments" 12 : 152-155, 2006

35 Mignogna MD, "Burning mouth syndrome responsive to duloxetine: a case report" 12 : 466-469, 2011

36 Klasser GD, "Burning mouth syndrome" 28 : 381-396, 2016

37 Grushka M, "An open-label, dose escalation pilot study of the effect of clonazepam in burning mouth syndrome" 86 : 557-561, 1998

38 Lee YC, "A review of SSRIs and SNRIs in neuropathic pain" 11 : 2813-2825, 2010

39 Woda A, "A possible therapeutic solution for stomatodynia (burning mouth syndrome)" 12 : 272-278, 1998

40 Heckmann SM, "A double-blind study on clonazepam in patients with burning mouth syndrome" 122 : 813-816, 2012