Complementary and Alternative Medical Therapies in Patients with Burning Mouth Syndrome

Dear Editor:

Burning mouth syndrome (BMS) is a common neurosensory disorder characterized by oral burning without evident clinical pathology or laboratory test findings. ^{1 –4}

The International Association for the Study of Pain defines BMS as pain located in the tongue or other mucosal membranes, in the absence of other clinical or laboratory test manifestations, and with duration of at least 4–6 months. BMS is characterized by chronic pain affecting mainly middle-aged or elderly women with hormonal changes or psychologic disorders. The pain usually ranges from moderate to intense, varies in intensity during the day, and generally lasts several years. ^{1 –6}

Many treatments such as sialogogues, topical anesthetics, oral rinses, antidepressants, benzodiazepines, anticonvulsants, anxiolytics, and psychologic therapy have been proposed on the basis of results from open studies or of clinical experience. ^{3 –5}

Complementary and alternative medical therapies (CAM) are becoming increasingly popular, yet little information is available on patterns of CAM use by patients with BMS.

We conducted a prospective observational study. Eighty-two (82) patients diagnosed with BMS were evaluated in the Department of Oral Medicine of the University of Murcia (Spain). The information was collected by means of a self-administered questionnaire assessing the use of CAM.

On analyzing the subjects according to whether CAM was used or not, no statistically significant differences were observed in relation to age, gender, marital status, employment, or educational level. Likewise, no significant differences were found in relation to the duration of the disease, the diagnostic latency period, or the type of treatment used for BMS.

The results of our study indicate that in the same way as patients with other disorders, an important proportion (40.24%) of the subjects with BMS include CAM in their treatment plans. ^{7 –9} This may be interpreted as an attempt to improve the disease conditions. Our data indicate a higher prevalence of medicinal herbal use versus other CAM modalities (acupuncture, chiropractics, hypnosis, etc.), compared with similar studies involving patients with other types of chronic pain. ⁷

Treatment of BMS remains uncertain and controversial, and includes a great variety of drugs. ^3,5 The outcomes of these treatments shows wide variation, but are generally poor in most patients, especially those with prevalent psychologic factors. These patients suffer from signs and symptoms of significant chronic pain that are difficult to control, measure, and follow up on.

The use of herbal therapies is an increasingly popular method to treat pain, either alone or as a complement to traditional medical approaches. Unfortunately, research demonstrating the efficacy of herbal therapies to treat pain is limited.

In some cases, treatment for BMS is unable to secure optimum control of symptoms, or alternatively treatment may give rise to unacceptable side-effects. As a result, patients often consider other alternatives. In our study, 33 patients (40.24%) chose CAM, the latter being perceived as effective in 39.3% of the cases, quite effective in 30.3%, ineffective in 27.2%, and associated with worsening of BMS in 3%.

On the other hand, 48.8% of the subjects using CAM were seen to have sought information on such therapy from their primary care physician. Therefore, physicians working with pain must be familiarized with the uses and potential risks of CAM. According to Astin et al., ⁷ negative attitudes or experiences with conventional medicine are surprisingly not indicative of the use of CAM. In this sense, in our series only 3.0% of the patients claimed to resort to CAM because of disappointment with conventional medicine.

Differences in the duration of BMS could be relevant to the results obtained, since pain chronicity is associated with a more likely lack of response to conventional treatment, and with the choice of other treatment options. However, in our study no significant differences were observed in relation to the duration of BMS.

Most of the patients using CAM in our series (48.8%) claimed to have done so based on information supplied by their personal physician; this represented an important opportunity for patient education. Our results therefore underscore the importance of health education in application to CAM, since many of the existing data have not been scientifically validated or subjected to rigorous review.

There is a great disparity of information between the acceptance of CAM on the part of patients and the few existing scientific studies on CAM in application to BMS. Further studies are therefore needed to establish the safety, efficacy, and mechanism of action of such treatment.