[Clinical aspects of diagnosis and treatment of glossodynia in elderly and senile people.]

Glossodynia is a disease that is difficult to diagnose and treat. Persons of older age groups are in the most risk of its occurrence. This is due to the fact that its etiological factors are: age-related changes, general somatic diseases, usage of some pharmacological drugs, changes in the psycho-emotional background. Due to the similarity of the clinical picture of glossodynia with other diseases of the oral cavity, the doctor is required to be thoughtful when diagnosing and differentiating glossodynia. Clinical methods of examination are used, paying most attention to the anamnesis of life and disease, assessment of the personal and emotional sphere of the patient. Clinico-functional, clinico-instrumental, and laboratory methods of examination are also used. In the treatment of glossodynia, attention should be paid not only to the elimination of symptoms, but also to its prevention. The main efforts should be aimed at combating the main links of pathogenesis. Treatment should be comprehensive, differentiated and personalized. As a result of many researchers work, certain principles of diagnostics and treatment of glossodynia have been developed, which will be considered in our work.

Unilateral glossodynia as a harbinger of an occult cerebellopontine angle tumour.

A woman in her late 80s with severe bronchomalacia was referred to a tertiary orofacial pain clinic for unexplained right unilateral glossodynia of progressive and continuous evolution for the past 8 months, spreading to the ipsilateral labiomental region, associated with ipsilateral hypoacusia. Local and general clinical examinations were unremarkable and routine blood work could not reveal any underlying systemic disease explaining the glossodynia and burning/pricking labiomental pain. Suspecting a painful trigeminal neuropathy secondary to a space-occupying lesion, a cerebral MRI was prescribed, revealing an ipsilateral cerebellopontine angle lesion, compatible with either a schwannoma or meningioma. This lesion invaded the root entry zones of cranial nerves V and VIII explaining the patient's oral pain and hypoacusia. Following a neurosurgical consultation where surgical treatment was rejected, her pain was successfully managed by topical pregabalin mouthwashes, to prevent any risk of respiratory depression related to her underlying severe bronchomalacia.

Examination of pain relief effect of Goreisan for glossodynia.

BACKGROUND: Pain in glossodynia may be severe; it may prevent patients from working, interfere with daily life activities, and necessitate a patient's visit to a medical institution for consultation and treatment. The pain may be described as persistent and burning (tingling, tingling) or stinging. Patients may complain of dry mouth (dryness), which is thought to cause inflammation of the tongue and gingival mucous membranes and increased pain. Medications are prescribed based on the symptoms of glossodynia, and the therapeutic effect is confirmed. However, each drug has side effects, for example, pain may reduce, but drowsiness and dizziness may occur; further, there is always a tendency of drowsiness.On the other hand, Goreisan, a Chinese herbal medicine, has already been used by physicians to treat pain in the oral and maxillofacial regions resulting from rapid changes in air pressure. However, the lack of high-quality clinical research has been of concern, and a randomized clinical trial to investigate the efficacy and safety of Goreisan for treatment of pain in glossodynia is warranted. METHODS/DESIGN: This multicenter, randomized, controlled study will involve patients treated for glossodynia-related pain. In the experimental group, Goreisan will be taken for 12 weeks in combination with conventional treatment. Participants in the control group will not take any Kampo medicine; only the standard treatment will be taken. Subsequently, the degree of pain will be assessed, and saliva tests of all the patients on their first visit will be performed. Goreisan will be taken at a dose of 7.5 g/d (minute 3) for 12 consecutive weeks. Twelve weeks later, the degree of pain of each patient will be assessed. DISCUSSION: The purpose of this study is to investigate the efficacy of Goreisan for pain reduction in patients undergoing treatment for glossodynia-related pain. If pain in glossodynia patients can be reduced by the administration of Goreisan, its candidacy as an alternative treatment for pain in glossodynia can be further supported by more reliable research. TRIAL REGISTRATION: The study was registered in the jRCTs071200017. URL https://jrct.niph.go.jp/latest-detail/jRCTs071200017.

Metastatic gastric adenocarcinoma of the tongue with initial symptoms of glossodynia.

A 60-year-old woman presented to our department with severe tongue pain. On initial examination, the mucosal surface of the tongue was intact but a hard submucosal mass on the dorsum of the tongue was detected on palpation. Magnetic resonance imaging demonstrated an ill-defined tumor in the intrinsic tongue muscles. Sequential whole-body positron emission tomography/computed tomography revealed a tumor of the pancreas apart from the tongue lesion, and upper gastrointestinal endoscopy revealed gastric mucosa ulceration. On biopsy, the tongue lesion was confirmed to be metastatic gastric adenocarcinoma, and the gastric ulcer was simultaneously diagnosed as poorly differentiated gastric adenocarcinoma. The definitive diagnosis was thus gastric adenocarcinoma and synchronous pancreatic cancer, with gastric carcinoma metastases to the tongue. We administered FOLFIRINOX treatment for pancreatic cancer and FLTAX treatment for gastric cancer. Because of difficulty with oral intake due to the growth of the tongue lesion, we administered palliative radiation therapy at a dose of 30 Gy in 10 fractions following which the patient was able to resume oral intake and was satisfied with this outcome. She died 8 months after her first visit to our department.

Síndrome de boca ardiente: descripción clínica, planteamiento fisiopatológico y una nueva opción terapéutica / Burning mouth syndrome: clinical description, pathophysiological approach, and a new therapeutic option

Introducción. El síndrome de la boca ardiente se define como sensación de ardor intrabucal, en ausencia de lesiones locales o patología sistémica que lo justifique. Se trata de una entidad con pobre respuesta a los tratamientos comúnmente utilizados, que puede resultar muy discapacitante. Métodos. Analizamos prospectivamente las características clínicas, demográficas y la respuesta a tratamiento de 6 casos de síndrome de la boca ardiente diagnosticados en las consultas de cefaleas de 2 hospitales de tercer nivel. Resultados. Se trata de 6 pacientes de sexo femenino, con edades entre 34 y 82 años, que referían síntomas compatibles con síndrome de la boca ardiente. En 5 pacientes, las molestias empeoraban a última hora del día y 4 referían mejoría de los síntomas con los movimientos linguales. En todos los casos la exploración neurológica fue normal, los estudios analíticos no mostraron alteraciones que justificaran los síntomas y en el examen odontológico no se evidenciaron lesiones intrabucales. Todas las pacientes habían sido tratadas previamente con los tratamientos convencionales, sin mejoría. Se instauró pramipexol a dosis entre 0,36mg y 1,05mg al día, con lo que se consiguió mejoría evidente en todos los casos, que persiste tras una media de 4 años de seguimiento. Conclusiones. El síndrome de la boca ardiente sigue siendo una entidad de etiología desconocida, que comparte ciertos patrones clínicos y respuesta al tratamiento con el síndrome de piernas inquietas. Los agonistas dopaminérgicos deberían considerarse como tratamiento de primera línea en esta entidad (AU)

Introduction. Burning mouth syndrome is defined as scorching sensation in the mouth in the absence of any local lesions or systemic disease that would explain that complaint. The condition responds poorly to commonly used treatments and it may become very disabling. Methods. We prospectively analysed the clinical and demographic characteristics and response to treatment in 6 cases of burning mouth syndrome, diagnosed at 2 tertiary hospital headache units. Results. Six female patients between the ages of 34 and 82 years reported symptoms compatible with burning mouth syndrome. In 5 of them, burning worsened at the end of the day; 4 reported symptom relief with tongue movements. Neurological examinations and laboratory findings were normal in all patients and their dental examinations revealed no buccal lesions. Each patient had previously received conventional treatments without amelioration. Pramipexol was initiated in doses between 0.36mg and 1.05mg per day, resulting in clear improvement of symptoms in all cases, a situation which continues after a 4-year follow up period. Conclusions. Burning mouth syndrome is a condition of unknown aetiology that shares certain clinical patterns and treatment responses with restless leg syndrome. Dopamine agonists should be regarded as first line treatment for this entity (AU)

FR-Glosodinia: novedades terapéuticas / RF-Burning Mouth Syndrome: new treatments

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Effectiveness of low-dose milnacipran for a patient suffering from pain disorder with delusional disorder (somatic type) in the orofacial region.

Glossodynia is chronic pain localized around the tongue, with no perceivable organic abnormalities. In the fields of oral and maxillofacial surgery, it is categorized as an oral psychosomatic disease. In contrast, psychiatric nosology classifies glossodynia as a pain disorder among somatoform disorders, per the DSM-IV. The patient was a 71-year-old woman who developed symptoms of glossodynia, specifically a sore tongue. In the decade before she presented to us, she had had bizarre symptoms of oral cenesthopathy such as the sensation that her teeth had become 'limp and floppy' and that she needles in her mouth. Treatment was attempted using several psychotropic drugs, but no satisfactory response was noted. Because the patient was referred to our outpatient clinic, we tried psychotropic therapy again. Additionally, valproic acid, tandospirone and sertraline were administered (in this order), but the patient still showed no response. However, when sertraline was changed to milnacipran, all symptoms disappeared in a short period. We suggest that a small dose of milnacipran can be effective for controlling oral cenesthopathy as well as glossodynia.

Kampo medicine, based on traditional medicine theory, in treating uncured glossodynia: efficacy in five clinical cases.

Glossodynia, or tongue pain, is resistant to conventional therapies. Kampo medicines were evaluated in patients suffering from incurable glossodynia. Patients were diagnosed by traditional Chinese medicine (TCM) theory in order to determine the appropriate herbal prescriptions. Five Japanese females (50-76 years old) with glossodynia refractory to conventional therapy were enrolled in this study. Small portions of rikkunshito, jiinkokato, hachimijiogan and ryutanshakanto worked for a female diagnosed with "Spleen" and "Heart" Yin deficiency, "Kidney" Yang deficiency and "Liver" Qi stagnation producing heat syndrome. Seishoekkito and bakumondoto were effective for a patient diagnosed with "Spleen Qi" deficiency and "Stomach" Yin deficiency producing heat syndrome. Rikkunshito, kamikihito and chikujountanto worked for a patient diagnosed with "Spleen Qi" and "Heart Yin" deficiency, stagnation of "Liver" Qi producing fire and "Gallbladder" Qi deficiency. Rokumijiogan, kamishoyosan and kambakutaisoto were effective for a patient with Yang rise based on Yin deficiency of "Kidney" and "Liver," and restless organ disorder based on Yin deficiency of 5 viscera. A patient diagnosed with "Spleen" Yang deficiency responded to a combination of anchusan and hangeshashinto. These patients with glossodynia had resolution of pain within 1 month of treatment. Herbal mixtures containing Ganoderam lucidum, not prescribed based on TCM theory, but effective for herpes virus infection, worked for a female suffering from glossodynia for 1 year after artificial teeth were placed, but required about 5 months to note improvement. Kampo medicines, properly prescribed based on TCM theory, quickly resolved the pain of refractory glossodynia.

Glossodynia and necrosis of the tongue caused by giant cell arteritis.

Spontaneous, endogenous pain in the tongue (glossodynia) is rare, particularly when this progresses to ulceration and necrosis of the tongue. We report the case of a 74-year-old woman who presented with glossodynia that eventually resulted in necrosis of the tongue. The diminished blood supply was the result of histologically confirmed giant cell arteritis.

Use of topiramate for glossodynia.

INTRODUCTION: Glossodynia is a multifunctional disorder characterized by painful sensations in the mouth and throat and especially on the tongue. It is commonly cured by long-term therapy with systemic regimens of anxiolytics, antidepressants, and anticonvulsants. CASE: We report here the case of a 65-year-old woman with a 4-month history of glossodynia. Clinical and laboratory evaluations performed the diagnosis of idiopathic glossodynia, and several treatments with carbamazepine and then with gabapentin induced the development of serious adverse reaction. Only treatment with topiramate has been able to induce a complete improvement of symptoms. DISCUSSION: The pathogenesis of idiopathic glossodynia remains unclear, since it recently has been suggested as a possible neuropathic basis of burning mouth syndrome, demonstrating an altered excitability in the trigeminal nociceptive pathway at peripheral and/or central nervous system level. The various mechanisms of topiramate, which act at different neural transmission levels, blocking sodium and calcium channels, enhancing GABA concentration, and decreasing glutamate function at postsynaptic site, may explain the effects of topiramate in our patient. CONCLUSION: Therefore, we suggest that topiramate could represent a useful therapeutic option in the treatment of glossodynia.

[The effectiveness of a benzydamine rinse in the management of stomato-glossopyrosis]. / Benzidamin-tartalmú szájöblítovel szerzett klinikai tapasztalatok a stomato- glossopyrosis kezelésében.

Burning mouth syndrome (BMS) is a frequent source of oral discomfort and sensation mainly at middle-aged or elderly women without identifiable local pathology. Forty-two patients with stomato-glossopyrosis were registered at the Department of Periodontology, Dental School, University Pécs, between August 2002 and January 2003. Oral clinical examination failed to identify physical explanation for the complaint of painful or burning mouth. After complete examination (blood test included), scaling, root planning and oral hygiene instructions were given. Six patients reported decreasing mucosal pain or burning. Two patients had iron-deficiency and Sjögren's syndrome was suspected and verified at another two patients. Thirty-two patients completed the benzydamine-study. They were divided into two groups. The study group (16 patients) rinsed with benzydamine containing solution, the control group (16 patients) received placebo solution for rinsing the same way for ten days. Differences were found between the two groups favouring the benzydamine containing solution. Pain reduction, mouth dryness and diminution of burning sensation were detected by means of visual analog scale (VAS). Benzydamine rinses could be effective in the management of BMS, but clinicians need to monitor patients for possible side effects in the case of long-term use.

[Clinical and fundamental investigations on recurrent glossodynia].

A type of oral lesion, so-called glossodynia has been on the increase recently. Glossodynia is a kind of psychosomatic disease in which the patient experiences chronic pain on the surface of the tongue. It has never been diagnosed as coming from organic or functional pain. Although glossodynia can be cured by antianxiety drugs, antidepressants, or autogenic training and so on, usually. These are not a desirable solution. We initially tried to administer the antifungal drug, ITCZ, to 65 glossodynia patients. Sixty-four of them were cured of tongue pain after 1-3 weeks. The effective rate of recovery was 98.5%. Only two patients experienced recurrence of pain after 15 and 17 weeks, respectively, and Candida albicans was isolated from the surface of their tongues. The nature of the recurrent strains was investigated by MICs against 4 antifungal drugs, ITCZ, MCZ, AMPH-B, and NYS, as well as by the API 20C Auxanogram biochemically, and a molecular epidemiologic study by PFGE. Each case of Candida albicans was almost the same before and after the administration of ITCZ. Above all, it is important to carefully inspect the candidiasis of the tongue and to initially administer antifungal drugs when the diagnosis is glossodynia.

Treatment of glossodynia with olanzapine.

A 73-year-old white male with a 6-month history of glossodynia, unresponsive to clotrimazole troches, cevimeline, triamcinolone dental paste, paroxetine, and lorazepam presented to the dermatology clinic for consultation. Work-up revealed no oral abnormalities and no underlying systemic disorder. He denied symptoms consistent with a psychiatric disorder. A detailed free amnestic assessment by a board certified Geriatric Psychiatrist (John S. Kennedy, MD) found that the patient was oppressed by the pain. He did not meet the criteria for major depression nor did he have any anxiety disorder or delusions. Because of the presence of dysphoria and anticipatory anxiety secondary to glossodynia, the patient was started on olanzapine. Improvement of pain symptoms were noted within 3 days with full resolution of symptoms at 1- and 3-month follow-ups. Dysphoria and anticipatory anxiety remitted fully upon pain relief.

El papel de gabapentina en el tratamiento de las enfermedades con manifestaciones cutáneas y dolor / The role of gabapentin in treating diseases with cutaneous manifestations and pain

Antecedentes. Gabapentina fue autorizada por primera vez por la Food and Drug Administration (FDA) en 1993 como tratamiento complementario de las crisis epilépticas parciales. En mayo de 2002 fue aprobada por la FDA para el tratamiento de la neuralgia postherpética. Este fármaco parece ser eficaz para el tratamiento del dolor, para las alteraciones de la sensación y el prurito asociado con las enfermedades dermatológicas, pero no se ha realizado ninguna revisión sobre sus usos. Métodos: Se realizaron búsquedas en Medline y Google, introduciendo los términos "Gabapentina" y "Neurontin". Se revisaron todos los artículos encontrados. Se evaluaron y se revisaron los contenidos de todos los artículos identificados que contenían referencias sobre tratamientos de enfermedades de la piel y sobre el dolor neuropático. Resultados: Se localizaron en Medline, aproximadamente, 1.200 artículos que se referían a gabapentina o neurontin. En 150 artículos se analizó el uso de gabapentina para el dolor neuropático, y neuritis o neuralgias de varios tipos. Aproximadamente, 20 artículos revisaron su uso en muchas enfermedades dermatológicas o enfermedades con manifestaciones dermatológicas, y se incluyó el análisis del control del dolor asociado con el cambio de los vendajes de la herida, eritromelalgia, dolor asociado al piloleiomioma, prurito braquiorradial, glosodinia, vulvodinia y distrofia simpática refleja. En 100 artículos se revisaron los efectos secundarios de gabapentina. Conclusiones: Gabapentina es un fármaco muy eficaz para el tratamiento del dolor y de la neuralgia postherpética. Puesto que los pacientes dermatológicos padecen dolor debido a tumores, después de la cirugía, junto con úlceras neuropáticas, y durante los cambios del vendaje de enfermedades graves, las aplicaciones de este fármaco parecen ser mútiples. En estudios futuros debe valorarse su papel en el tratamiento del prurito y otras enfermedades dermatológicas que conllevan dolor o alteración de la sensación (AU)

Incidence and treatment of dysgeusia in patients with glossodynia.

In 96 patients who visited our hospital with glossodynia, we conducted gustatory tests, measured serum zinc and copper levels, examined lingual papillae using biomicroscopy, conducted psychological tests and investigated the effectiveness of treatments directed at the cause of dysgeusia. Gustatory test results showed that 43 (44.8%) of the patients had dysgeusia, which was mild in 62.8%, moderate in 30.2% and severe in 7.0%. By giving higher priority to treatment of dysgeusia than to glossodynia, pain disappeared or was relieved and gustatory sensation improved in 27 (62.8%) of these 43 patients. Overall, pain disappeared or was improved in 65 (67.7%) cases. When treating glossodynia, it is important to diagnose the cause of pain and to give higher priority to treating that cause. The clinical efficacy of treatment for glossodynia will be improved when the presence or absence of dysgeusia is diagnosed early in the course of treatment.