Abstract
Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue or other oral mucous membrane, usually in the absence of other abnormal findings. In many cases, it has been very difficult to treat. We recently observed the relief of symptoms in a case of BMS with psychogenic factors by psychotherapy provided during hospitalization.
The patient was a 77-year-old woman who came to our Orofacial Pain Clinic in January 2004. Her chief complaint was palatal pain caused by the sensation of a foreign substance sticking to the palatal membrane. She had felt the abnormal sensation after starting inhalation therapy for asthma with a steroid solution in 1999. She had often complained of this as a side effect and changed the medicine several times, but the sensation had not disappeared. The inhalation therapy was terminated in January 2003, but the burning pain recurred when she ate hot rice cakes. Her palatal membrane was normal. The burning pain and tingling worsened after meals, and she also complained of a dry mouth. Psychological tests revealed that she was mildly depressive and had a psychosomatic personality marked by dependency and anxiety. We diagnosed her symptoms as BMS and xerostomia.
We started brief psychotherapy and kanpotherapy with Bakumon-do-to. Four weeks later, she complained she had not been able to take anything for severe pain since the previous night. She also suffered from insomnia, loss of appetite and desperation, and alluded to suicide.
We decided to hospitalize her for treatment. There, we continued with brief psychotherapy and gave her SSRIs without analgesics. In view of her dependency and anxiety, because she lived alone, we chose supportive therapy in order to improve her adaptability. Her pain was gradually reduced and we then recommended music therapy, too, which proved effective for providing relaxation and pain relief. After 10 days of hospitalization, her pain was relieved, and her insomnia and loss of appetite had been ameliorated.
This case suggested that the psychogenic factors of her dependent personality and anxiety living alone had caused her to develop severe BMS. It is proposed that the provision of psychotherapy in hospital is useful in severe cases of BMS.
