J Oral Facial Pain Headache. 2019 Summer;33(3):278–286. doi: 10.11607/ofph.2358. Epub 2019 Mar 20.
To compare somatosensory function profiles and psychologic factors in patients with primary burning mouth syndrome (BMS) and healthy controls and to evaluate correlations of subjective pain ratings with somatosensory and psychologic parameters.
A quantitative sensory testing (QST) protocol-including cold detection threshold (CDT), warmth detection threshold (WDT), thermal sensory limen (TSL), paradoxical heat sensation (PHS), cold pain threshold (CPT), heat pain threshold (HPT), mechanical pain threshold (MPT), wind-up ratio (WUR), and pressure pain threshold (PPT)-was performed at the oral mucosa of the tongue, buccal, and palatal sites in 30 Chinese patients (25 women and 5 men, mean age 50.9 ± 9.2 years) with primary BMS and in 18 age- and gender-matched healthy controls (15 women and 3 men, mean age 53.2 ± 7.0 years). For each BMS patient, z scores and loss/gain scores were computed. Psychologic status was evaluated in both groups using the Self-Rating Anxiety Scale and Self-Rating Depression Scale. Correlations of BMS patients' subjective pain ratings with somatosensory and psychologic profiles were assessed with the use of Pearson or Spearman correlations and multiple linear regression.
In BMS patients, 53.3% had somatosensory abnormalities according to z scores vs 22.2% of healthy controls (P = .033). The abnormalities in BMS patients were somatosensory loss to thermal nonnoxious stimuli (TSL = 20.0%, CDT = 13.3%, WDT = 13.3%), mechanical pressure stimuli (PPT = 16.7%), pinprick stimuli (MPT = 6.7%), and thermal pain stimuli (CPT = 3.3%), and somatosensory gain to repetitive pinprick stimuli (WUR = 6.7%), pressure stimuli (PPT = 6.7%), and thermal pain stimuli (HPT = 3.3%). The most frequent loss/gain score was 13.3% for loss of thermal somatosensory function with no somatosensory gain; 13.3% for loss of thermal and mechanical somatosensory function with no somatosensory gain; and 13.3% for gain of mechanical somatosensory function with no somatosensory loss. Mild elevations in anxiety scores were seen in 30% of the BMS patients, and 50% and 36.7% had mild and moderate elevations, respectively, in depression scores. No anxiety or depression was detected in the control group. QST results, but not psychologic scores, were significantly correlated with patients' subjective pain ratings (PHS, Spearman coefficient -0.384, P = .029; CPT, Pearson coefficient -0.370, P = .034; MPT, Pearson coefficient -0.376, P = .032; PPT, Pearson coefficient 0.363, P = .037).
The present findings documented distinct differences in somatosensory function in patients with primary BMS compared to controls, indicating a complex pathophysiology and interaction between impairments in nociceptive processing and psychologic functioning.
比较原发性灼口综合征（BMS）患者和健康对照者的躯体感觉功能谱和心理因素，并评估主观疼痛评分与躯体感觉和心理参数的相关性。
对 30 例中国原发性 BMS 患者（25 名女性，5 名男性，平均年龄 50.9±9.2 岁）和 18 名年龄和性别匹配的健康对照者（15 名女性，3 名男性，平均年龄 53.2±7.0 岁）的舌、颊和腭黏膜进行定量感觉测试（QST）方案，包括冷觉检测阈值（CDT）、温觉检测阈值（WDT）、热感觉阈值（TSL）、矛盾热感觉（PHS）、冷痛觉阈值（CPT）、热痛觉阈值（HPT）、机械痛觉阈值（MPT）、升速比（WUR）和压力痛觉阈值（PPT）。对每位 BMS 患者计算 z 分数和得失分数。使用焦虑自评量表和抑郁自评量表评估两组患者的心理状态。使用 Pearson 或 Spearman 相关和多元线性回归评估 BMS 患者主观疼痛评分与躯体感觉和心理特征的相关性。
BMS 患者中，53.3%根据 z 分数出现躯体感觉异常，而健康对照组为 22.2%（P=0.033）。BMS 患者的躯体感觉异常为热非伤害性刺激的感觉丧失（TSL=20.0%，CDT=13.3%，WDT=13.3%）、机械压力刺激（PPT=16.7%）、针刺刺激（MPT=6.7%）和热痛刺激（CPT=3.3%），以及热痛刺激（CPT=3.3%）和热痛刺激（CPT=3.3%）的感觉增益。最常见的得失分数为热感觉功能丧失而无感觉增益的 13.3%；热和机械感觉功能丧失而无感觉增益的 13.3%；机械感觉功能增益而无感觉丧失的 13.3%。30%的 BMS 患者出现轻度焦虑评分升高，50%和 36.7%分别出现轻度和中度抑郁评分升高。对照组未发现焦虑或抑郁。QST 结果，但不是心理评分，与患者的主观疼痛评分显著相关（PHS，Spearman 系数-0.384，P=0.029；CPT，Pearson 系数-0.370，P=0.034；MPT，Pearson 系数-0.376，P=0.032；PPT，Pearson 系数 0.363，P=0.037）。
本研究结果表明，原发性 BMS 患者与对照组相比，躯体感觉功能存在明显差异，提示疼痛处理和心理功能障碍之间存在复杂的病理生理学和相互作用。
