Burning Mouth Syndrome (BMS) is a chronic pain disorder characterized by a persistent burning sensation in the oral cavity without any visible mucosal abnormalities. This article explores the nature of BMS, its impact on sufferers, current treatment modalities, and the potential role of stellate ganglion block (SGB) as an emerging therapeutic option.
Understanding Burning Mouth Syndrome
BMS manifests as a persistent burning, scalding, or tingling sensation, predominantly affecting the tongue, lips, gums, or the entire mouth. The etiology of BMS remains largely idiopathic, though several mechanisms have been proposed, including neuropathic dysfunction, hormonal changes, and psychological factors. Epidemiologically, BMS affects approximately 2% of the population, with a higher prevalence observed in postmenopausal women (Jääskeläinen & Woda, 2017).
Burning mouth syndrome treatment and relief can be difficult to find. The Stellate Ganglion Block procedure is showing great promise as a treatment option for this troubling condition.
Proposed Mechanisms Underlying Burning Mouth Syndrome
The exact pathophysiology of BMS is not fully understood, but several hypotheses have been proposed:
Neuropathic Dysfunction: Evidence suggests that BMS may involve small fiber neuropathy affecting the intraoral mucosal epithelium. Studies have shown a decreased density of nerve endings and increased activity of transient receptor potential cation channel subfamily V member 1 (TRPV1) channels in the tongues of BMS patients, indicating peripheral nerve alterations (Jääskeläinen & Woda, 2017).
Central Nervous System Changes: Functional MRI studies have demonstrated altered brain activity in regions associated with pain processing in BMS patients, suggesting central sensitization as a contributing factor (Momota et al., 2013).
Hormonal Factors: The higher prevalence of BMS in postmenopausal women points toward a potential link with hormonal changes, particularly decreased estrogen levels affecting oral mucosal health (Jääskeläinen & Woda, 2017).
Psychological Components: Psychiatric comorbidities such as anxiety and depression are more prevalent in individuals with BMS, indicating that psychological factors may exacerbate or even precipitate symptoms (Bs et al., 2022).
The Experience of Burning Mouth Syndrome
Individuals with BMS often report a sudden onset of oral burning sensations that intensify throughout the day. This relentless discomfort can lead to difficulties in eating, speaking, and swallowing, significantly impairing quality of life. Accompanying symptoms may include dry mouth and altered taste perceptions (Jääskeläinen & Woda, 2017).
Current Treatment Approaches
Managing BMS is challenging due to its unclear etiology. Treatment strategies are primarily symptomatic and may involve:
Pharmacotherapy: Utilizing medications such as tricyclic antidepressants, benzodiazepines, or anticonvulsants to modulate neuropathic pain (Bs et al., 2022).
Topical Therapies: Application of capsaicin or clonazepam to provide localized relief (Jääskeläinen & Woda, 2017).
Behavioral Interventions: Cognitive-behavioral therapy to address associated psychological factors (Bs et al., 2022).
Despite these interventions, many patients continue to experience refractory symptoms, prompting the exploration of alternative treatments.
Stellate Ganglion Block: An Overview
The stellate ganglion is a collection of sympathetic nerves located in the neck, playing a crucial role in modulating autonomic functions, including pain perception. A stellate ganglion block involves the injection of a local anesthetic to temporarily disrupt sympathetic nerve activity. This procedure has been employed in managing various pain conditions, particularly those with a sympathetically maintained component (Noma et al., 2013).
Evidence for Stellate Ganglion Block in Burning Mouth Syndrome
Emerging evidence suggests that Stellate Ganglion Block (SGB) may offer relief for patients suffering from refractory BMS. In a notable study by Zong-Zhe (2008), 48 patients with persistent BMS underwent SGB. The outcomes were promising, with 48% of patients achieving complete relief, 44% experiencing improvement, and an overall efficacy rate of 92%. These findings indicate that SGB could be a viable treatment option for those unresponsive to conventional therapies.
Further supporting this, Walega et al. (2014) presented a case where a patient with severe, unrelenting oral pain due to BMS underwent bilateral SGB. The intervention resulted in significant pain reduction, underscoring the potential of SGB in managing intractable BMS cases (Walega et al., 2014).
While these early studies are encouraging, it is important to recognize that the current body of evidence is limited. Larger, controlled trials are necessary to establish standardized treatment protocols and to confirm the long-term efficacy and safety of SGB in the context of BMS.
Summary
Burning Mouth Syndrome presents a significant challenge due to its complex etiology and refractory nature. Stellate ganglion block has emerged as a promising therapeutic option, especially for patients unresponsive to conventional treatments. Incidentally, the sphenopalatine ganglion block has shown some benefit in treating refractory BMS, with studies indicating its role in modulating pain pathways associated with the syndrome (Bs et al., 2022). Neuregen offers stellate ganglion block in Scottsdale, Arizona with other innovative therapies, including sphenopalatine ganglion block, neurorehabilitation, regenerative medicine, and ketamine therapy, offering a comprehensive, multimodal approach to managing BMS and other orofacial pain syndromes.
References
Bs, J., Bs, T., Sabido, L., Riazuddin, I., Blankespoor, E., Haque, A., & Medina, M. (2022). Bilateral Sphenopalatine Ganglion Blocks for Refractory Burning Mouth Syndrome. Pain Medicine Case Reports. https://doi.org/10.36076/pmcr.2022.6.277
Jääskeläinen, S., & Woda, A. (2017). Burning mouth syndrome. Cephalalgia, 37(7), 627-647. https://doi.org/10.1177/0333102417694883
Momota, Y., Takano, H., Kani, K., Matsumoto, F., Motegi, K., Aota, K., Yamamura, Y., Omori, M., Tomioka, S., & Azuma, M. (2013). Frequency analysis of heart rate variability: A useful assessment tool of linearly polarized near-infrared irradiation to stellate ganglion area for burning mouth syndrome. Pain Medicine, 14(3), 351-357. https://doi.org/10.1111/pme.12008
Noma, N., Kamo, H., Nakaya, Y., Dezawa, K., Young, A., Khan, J., & Imamura, Y. (2013). Stellate ganglion block as an early intervention in sympathetically maintained headache and orofacial pain caused by temporal arteritis. Pain Medicine, 14(3), 392-397. https://doi.org/10.1111/pme.12040
Walega, D. R., Smith, C. G., Epstein, J. B., & Udoji, E. N. (2014). Stellate ganglion block for the treatment of complex regional pain syndrome and its associated conditions: A case-based review. Regional Anesthesia and Pain Medicine, 39(6), 506-511. https://doi.org/10.1097/AAP.0000000000000168
Zong-Zhe, Y. (2008). Adopting stellate ganglion block to treat refractoriness burning mouth syndrome. Journal of Clinical Stomatology.
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