The patient was a 56-year-old female who complained of a burning pain on her tongue. The pain was continuous except eating and sleeping time and was accompanied by dry mouth and headache. We diagnosed her as having burning mouth syndrome (BMS) based on the exclusion of any local factors (e.g., candidiasis, hyposalivation, mucosal lesions, trauma) or systemic conditions (e.g., vitamin deficiency, diabetes, hypothyroidism, side effect of medications, autoimmune disorders). Only a psychometric test yielded high scores.
Since the patient had not only tongue pain but additional sign and symptoms such as edema and scalloped tongue, dry mouth and headache, we planned to use lidocaine and goreisan, which is a kampo medicine, based on the results of a numerical rating scale (NRS). A referral to a psychiatrist was considered. However, 3 years have passed since her initial visit, and her condition has been successfully managed using only goreisan.
The etiology of BMS is unclear, but psychological factors often trigger pain in many cases. Recent evidence shows neuropathic mechanisms involving both the peripheral and central nervous systems in the etiology of BMS. If BMS is approached as a neuropathic pain condition, the use of lidocaine is reasonable as both a diagnostic tool and an initial therapy for BMS. Kampo medicine can be useful as a complementary alternative medicine.
Here, we introduce a case of BMS with dry mouth that was successfully managed using goreisan.
