CLEVELAND-For people who suffer from burning mouth syndrome, low doses of the drug clonazepam may offer significant relief, according to a study by a Case Western Reserve University professor in the November issue of Oral Surgery.
About 1.3 million American adults, mostly postmenopausal women, are afflicted with burning mouth syndrome (BMS), a chronic, often debilitating condition whose cause remains a medical mystery. Only in recent years has science begun to seek an organic basis for the intense burning pain, notes researcher Miriam Grushka, an associate professor of oral diagnosis at the CWRU School of Dentistry.
"Until the late 1980s or early '90s, it was treated as an emotional problem that was thought to be associated with depression, anxiety, or other neuroses," says Grushka, a pioneer in the treatment of BMS. Although recent research has focused on various physical explanations for burning mouth, there is no consensus on the cause or treatment.
BMS seems to follow a pattern in many sufferers, Grushka observes. The burning pain begins by late morning and usually reaches peak intensity by evening, which makes falling asleep difficult yet doesn't awaken the patient during the night.
Grushka's study tested the effect of clonazepam, a form of benzodiazepine that is often used an anticonvulsant. Her sample consisted of 30 patients who had experienced BMS for anywhere from one month to 12 years. One subject was an 83-year-old male and the rest were females age 45 to 87 (with a median age of 65).
The patients began taking 0.25 mg of clonazepam at bedtime for one week and could increase the daily dose by as much as 0.25 mg each week, up to a total dosage of 3 mg.
"Patients were carefully instructed about increasing the dose only until they either experienced significant pain relief or until they experienced untoward side effects, especially drowsiness," Grushka reports.