Watanabe Motoko, Takao Chihiro, Liu Zhenyan, Nayanar Gayatri, Suga Takayuki, Hong Chaoli, Tu Trang Thi Huyen, Yoshikawa Tatsuya, Takenoshita Miho, Motomura Haruhiko, Nagamine Takahiko, Toyofuku Akira
Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Basic Dental Sciences, Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Front Pain Res (Lausanne). 2022 Mar 4;3:809207. doi: 10.3389/fpain.2022.809207. eCollection 2022.
Burning mouth syndrome (BMS) is defined by chronic oral burning sensations without any corresponding abnormalities. Besides amitriptyline, aripiprazole has been reported as a possible medication to manage BMS. However, especially for elderly patients, the adverse events of these medications would be a problem. The aim of the present study was to investigate the differences in the effectiveness and adverse events of amitriptyline and aripiprazole in very elderly patients with BMS. This is a retrospective comparative study of 80 years old and older patients with BMS who were initially treated with amitriptyline or aripiprazole and who were new outpatients of our department from April 2017 to March 2020. All clinical data, including sex, age, comorbid physical diseases, comorbid psychiatric disorders, the prescribed doses (initial, maximum, and effective dose), prognosis, and adverse events, were collected from their medical charts. Each medication was selected considering their medical history. Amitriptyline was prescribed in 13 patients (11 women, 82.3 ± 2.1 years old) and aripiprazole was prescribed in 27 patients (26 women, 84.2 ± 3.8 years old). There were no significant between-group differences in sex, age, duration of illness, pain intensity, salivation, and psychiatric comorbidity at the first examination. Amitriptyline clinically improved more patients (7 patients, 53.8%) with the effective dose of 10 (7.5, 15.0) mg than aripiprazole (11 patients, 40.7%) of which the effective dose was 1.0 (0.5, 1.5) mg, although there were no significant between-group differences. The adverse events of amitriptyline were found in 9 patients (69.2%) and most patients had constipation (46.2%). For aripiprazole, 7 patients (25.9%) showed adverse events, most of them reported sleep disorder (11.1%). Amitriptyline had significantly longer duration taking medication ( = 0.021) and lower discontinuation ( = 0.043) despite of higher occurrence rate of adverse events ( = 0.015) compared to aripiprazole. These results suggest that both psychopharmacotherapies with a low dose of amitriptyline and aripiprazole are effective for the very elderly patients with BMS. Furthermore, aripiprazole may have some advantages in the adverse events compared to amitriptyline; however, the low dose amitriptyline monotherapy may have more benefit in the effectiveness and tolerability over prudent collaboration with primary physicians.
灼口综合征（BMS）的定义为存在慢性口腔烧灼感但无任何相应异常。除了阿米替林外，阿立哌唑也被报道为一种可能用于治疗BMS的药物。然而，尤其是对于老年患者，这些药物的不良事件会成为一个问题。本研究的目的是调查阿米替林和阿立哌唑在高龄BMS患者中的疗效和不良事件差异。这是一项回顾性比较研究，研究对象为2017年4月至2020年3月期间在我科初诊并首次接受阿米替林或阿立哌唑治疗的80岁及以上BMS患者。从他们的病历中收集了所有临床数据，包括性别、年龄、合并的躯体疾病、合并的精神障碍、规定剂量（初始剂量、最大剂量和有效剂量）、预后和不良事件。根据他们的病史选择每种药物。13例患者（11名女性，年龄82.3±2.1岁）服用了阿米替林，27例患者（26名女性，年龄84.2±3.8岁）服用了阿立哌唑。首次检查时，两组在性别、年龄、病程、疼痛强度、流涎和精神合并症方面无显著组间差异。阿米替林有效剂量为10（7.5，15.0）mg时，临床改善的患者更多（7例，53.8%），而阿立哌唑有效剂量为1.0（0.5，1.5）mg时，临床改善的患者为11例（40.7%），尽管组间差异无统计学意义。9例（69.2%）服用阿米替林的患者出现了不良事件，大多数患者有便秘（46.2%）。对于阿立哌唑，7例（25.9%）患者出现了不良事件，其中大多数报告有睡眠障碍（11.1%）。与阿立哌唑相比，尽管阿米替林不良事件发生率较高（P = 0.015），但其服药持续时间显著更长（P = 0.021）且停药率更低（P = 0.043）。这些结果表明，低剂量的阿米替林和阿立哌唑这两种心理药物治疗方法对高龄BMS患者均有效。此外，与阿米替林相比，阿立哌唑在不良事件方面可能有一些优势；然而，低剂量阿米替林单药治疗在疗效和耐受性方面可能比与初级医生谨慎合作更有益。
