Abstract
For patients with severe oral psychosomatic symptoms who struggle in their daily lives, hospitalization with sufficient treatment duration could be useful. However, due to recent changes in the Japanese health insurance system, it is becoming more difficult to receive long hospitalization. In addition, the change in environment might worsen the symptoms of burning mouth syndrome（BMS）, especially in elderly patients. A strategy to manage patients with severe symptoms in the outpatient setting is therefore required. With careful observation of side effects, support from the family, patient education and careful dose adjustment, patients with severe BMS symptoms could be managed successfully without hospitalization. A 68-year-old female presented burning tongue sensation, dry mouth sensation and dysgeusia for 3 months before her first visit. The severe oral symptoms caused insomnia, loss of appetite and fatigue. She could not do any housework and lay on a bed all day. We diagnosed her pain as BMS. We started treatment with 10mg of amitriptyline. Amitriptyline was titrated carefully and quickly up to a single bedtime dose of 40mg. The burning pain of the tongue almost resolved within 1month and she recovered to her normal life by 5 months from the initial visit. Regarding side effects, drowsiness, dry mouth, weight gain of 2kg and constipation were reported, but there were no serious side effects.
