Oral cenesthopathy is characterized by various symptoms from sticky and slimy sensations to bizarre complaints such as coils, wires, or screws without corresponding organic abnormalities, and sometimes involves pain sensations. It is typically difficult to treat since many factors including psychosocial problems interact in a complicated manner. Herein, we present a rare case whose oral cenesthopathy comorbid pain sensations showed much improvement with low-dose amitriptyline monotherapy, considering the psychosocial background.
A 66-year-old female complained of foreign objects with various shapes coming from inside of the left side of her neck and moving into her oral cavity accompanied by stinging and stubbing strong pain. She remained objective and showed understanding of her sensations and psychopharmacotherapy. In addition, her husband had been very understanding and supportive. There was no sign of depression, catastrophizing or intolerability of uncertainty and no abnormal finding in her cognitive function or in brain magnetic resonance images. Hyperfusion in the frontal to temporal regions, which are reported to have a specific pattern in patients with oral cenesthopathy, were observed by single photon emission computed tomography （SPECT）.
She was diagnosed as having oral cenesthopathy. Since these symptoms are generally refractory, the first aim was to relieve the pain, even if only a little. For this aim, amitriptyline was prescribed with the initial dose of 10mg. On day 21, the pain sensations were improving. Her husband had been supportive and always offered thoughtful words to help her accept her feelings. Amitriptyline was increased up to 30mg and almost removed the pain sensations by day 70; however, amitriptyline was decreased to 25mg since dementia-like symptoms were suspected. On day 98, the sensation of movement of foreign objects also improved gradually, and no dementia-like symptoms were found. On day 133, foreign body sensations greatly improved and stabilized with 25mg of amitriptyline by day 217. The asymmetric patterns in SPECT tended to be reduced.
In the present case, not only the pain sensations but also the foreign body sensations were substantially improved with low-dose amitriptyline. Besides the pharmacological effects of amitriptyline, no psychological problems, good understanding of the disease, sharing of the aim of treatment, and the family’s understanding and support had synergistic effects.