Department of Preventive Medicine, Tokushima University, Tokushima, Japan.
Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Clin Neuropharmacol. 2024;47(2):33-36. doi: 10.1097/WNF.0000000000000583. Epub 2024 Jan 30.
Burning mouth syndrome (BMS) is an intractable chronic pain disorder characterized by a burning sensation without organic abnormalities in the oral mucosa. Amitriptyline may be effective for BMS or, conversely, may exacerbate pain. QTc is necessary for monitoring psychotropic adverse effects, but it is not known if it is a predictor of efficacy for BMS. We investigated the efficacy of amitriptyline in BMS and its effect on QTc.
Visual analog scale and electrocardiogram were examined before and 1 month after treatment in 51 consecutive patients diagnosed with BMS according to the International Classification of Headache Disorders, Third Edition (ICHD-3), criteria and treated with amitriptyline.
There were 26 amitriptyline responders and 25 nonresponders, with no differences in age, sex, and amitriptyline dosage. Amitriptyline responders showed little change in QTc, whereas nonresponders showed a trend toward significantly shorter QTc. Changes in visual analog scale correlated statistically significantly with changes in QTc (Spearman rank correlation coefficient: 0384; P = 0.0054). The degree of pain tended to worsen with QTc shortening.
Amitriptyline provides analgesia in about half of BMS patients, but some BMS patients have worse pain with amitriptyline. Not only do changes in the QTc detect amitriptyline adverse effects with prolongation, but also, conversely, its shortening predicts amitriptyline ineffectiveness.
灼口综合征（BMS）是一种无法治愈的慢性疼痛疾病，其特征是口腔黏膜无器质性异常，但有烧灼感。阿米替林可能对 BMS 有效，或者相反，可能会加重疼痛。QTc 是监测精神药物不良反应所必需的，但尚不清楚其是否是 BMS 疗效的预测指标。我们研究了阿米替林治疗 BMS 的疗效及其对 QTc 的影响。
根据国际头痛疾病分类，第三版（ICHD-3）标准诊断为 BMS 的 51 例连续患者接受阿米替林治疗，在治疗前和治疗后 1 个月分别进行视觉模拟量表和心电图检查。
有 26 例阿米替林应答者和 25 例无应答者，在年龄、性别和阿米替林剂量方面无差异。阿米替林应答者的 QTc 几乎没有变化，而无应答者的 QTc 则呈缩短趋势。视觉模拟量表的变化与 QTc 的变化呈统计学显著相关（Spearman 等级相关系数：0.384；P = 0.0054）。疼痛程度随着 QTc 的缩短而趋于恶化。
阿米替林能为大约一半的 BMS 患者提供镇痛，但一些 BMS 患者在服用阿米替林后疼痛加重。QTc 的变化不仅能检测到阿米替林的不良反应（延长），而且其缩短也能预测阿米替林的无效性。
