FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

"BMS" -- LIKE PEPPERS -- CAN SET YOUR MOUTH ON FIRE!

Question: My sister-in-law has burning pain in her mouth and face. She has gone to many physicians and spent thousands of dollars without getting any relief. All they have told her is that she has “Burning Mouth Syndrome.” What causes this problem, and isn’t there something she can do besides applying ice when it hurts?

Answer: A syndrome is a group of symptoms that occur together with sufficient frequency that we doctors think there must be a common underlying disorder. The cluster of symptoms in Burning Mouth Syndrome, or BMS, provide a good example -- pain, usually of a burning nature, of the tongue, cheeks, gums and face.
There are a number of disorders that can cause mouth pain. Ill-fitting dentures, an abscessed tooth, even migraine headaches can cause this common complaint. Your sister-in-law “spent thousands of dollars” to find out that she doesn’t have one of the other known disorders but instead suffers from BMS.

This syndrome may be more common in women than in men. The reason for the wiggle-word “may” is that women are more likely to go to their doctors when they have a new medical complaint. Men, on the other hand, tend to just complain to their wives rather than to the doctor. So, if a greater proportion of women with this syndrome go to see their doctors, then more women are likely to end up seeing doctors who are doing research in this area. This makes them more likely to show up in the statistics. With this limitation in mind, the statistics show that women have this disorder about three times more often than men.

Burning Mouth Syndrome usually begins without injury or other memorable event to denote the first episode of pain. It typically begins some time after age 50 -- with distinct incidents of mouth pain. The sufferer often awakens feeling fine but has increased discomfort as the day wears on.

Researchers have tried to link this disorder with low levels of estrogen, zinc, vitamin C and other measurable metabolic parameters such as kidney function and diabetes. Despite these efforts medical science hasn’t identified the exact underlying cause for this problem.

The lack of a known cause doesn’t mean that there aren’t some treatments worth trying for BMS. This is because we do know something about how the sensation of pain is experienced. For instance, we are aware that specific types of nerve stimulation are carried by sensory nerves to the brain, where they are interpreted as pain. Medicines that either modify the transmission of these “pain signals” or reduce the brain’s response to them are of some value.

While non-prescription pain medicines work in this fashion, many sufferers require stronger prescription pain drugs for adequate relief. Painkillers alone work for some individuals, but others get relief when they add an antidepressant medicine to their treatment measures. Antidepressants may benefit the person by its influence on pain signals and also by helping with the depression that frequently goes along with any chronically painful condition.

Medicines that are useful in controlling some types of epilepsy can also be beneficial for individuals with Burning Mouth Syndrome. Carbamazepine, the generic name of Tegretol, and gabapentin (Neurontin) are the ones most commonly tried. Instead of prescribing these, your sister-in-law’s doctors have chosen to follow the conservative approach of “do no harm.” In many cases this is wise, because all of these medicines can have undesirable effects -- some worse than the BMS itself. If she is truly miserable with her pain, however, I would urge her to go back to the most knowledgeable doctor she’s seen and ask about trying one of the medicines that sometimes gives relief.

"Family Medicine" is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.