Takahashi Kaori, Kasahara Satoshi, Takahashi Miwako, Morita Taito, Sato Naoko, Momose Toshimitsu, Matsudaira Ko, Niwa Shin-Ichi, Uchida Kanji, Handa Toshiyuki, Ichinohe Tatsuya, Fukuda Ken-Ichi
Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
Front Pain Res (Lausanne). 2025 Apr 23;6:1536584. doi: 10.3389/fpain.2025.1536584. eCollection 2025.
Burning mouth syndrome (BMS) is an idiopathic oral pain disorder characterized by burning sensations and dysesthesia, often complicated by psychosocial factors and psychiatric comorbidities, necessitating a multidisciplinary approach. BMS, classified as nociplastic pain (NcplP), frequently involves central sensitization. Attention-deficit/hyperactivity disorder (ADHD), a neurodevelopmental disorder, is commonly comorbid with NcplP, and ADHD-targeted treatment has shown efficacy in NcplP management. However, the role of ADHD diagnosis and treatment on BMS and associated brain function abnormalities remains unexplored. Therefore, we aimed to investigate the prevalence of ADHD comorbidity and its assessment using ADHD scales and the therapeutic efficacy of an ADHD-focused algorithm, including pre- and post-treatment cerebral blood flow single-photon emission computed tomography (SPECT) results, in patients with treatment-resistant BMS referred from the outpatient clinic of dental psychosomatic specialists at a tertiary care institution for multidisciplinary treatment.
We retrospectively analyzed data from 14 patients with treatment-resistant BMS who received multidisciplinary care, including psychiatric evaluation and SPECT imaging. Clinical assessments included the Conners' Adult ADHD Rating Scale (CAARS-S and CAARS-O), Pain Numerical Rating Scale, Hospital Anxiety and Depression Scale, and Pain Catastrophizing Scale. Algorithm-based pharmacotherapy using ADHD-effective medications (methylphenidate, atomoxetine, guanfacine, aripiprazole, venlafaxine, and duloxetine) was administered.
ADHD was diagnosed in 13 patients (92.9%), with 57.2% exhibiting borderline or clinical-level symptoms. Clinically significant improvements were observed in all clinical scales among the 10 patients who completed algorithm-based treatment. Brain perfusion SPECT identified hypoperfusion in the frontal lobe and hyperperfusion in the perigenual anterior cingulate cortex, insular cortex, posterior cingulate gyrus, and precuneus in 90% of cases, with improvements noted following treatment.
ADHD is frequently comorbid in patients with treatment-resistant BMS, and ADHD-targeted pharmacotherapy may help alleviate pain, cognitive dysfunction, and brain perfusion abnormalities. These findings suggest that ADHD screening, diagnosis, and multidisciplinary management involving psychiatrists could play a crucial role in optimizing clinical outcomes in patients with BMS.
灼口综合征（BMS）是一种特发性口腔疼痛障碍，其特征为烧灼感和感觉异常，常伴有心理社会因素和精神共病，因此需要多学科方法进行治疗。BMS被归类为神经病理性疼痛（NcplP），常涉及中枢敏化。注意缺陷多动障碍（ADHD）是一种神经发育障碍，通常与NcplP共病，针对ADHD的治疗已显示出对NcplP管理有效。然而，ADHD诊断和治疗对BMS及相关脑功能异常的作用仍未得到探索。因此，我们旨在调查ADHD共病的患病率，使用ADHD量表对其进行评估，并研究针对ADHD的算法治疗效果，包括治疗前后脑血流单光子发射计算机断层扫描（SPECT）结果，这些研究对象为来自一家三级医疗机构牙科心身专科门诊转诊来接受多学科治疗的难治性BMS患者。
我们回顾性分析了14例接受多学科护理（包括精神评估和SPECT成像）的难治性BMS患者的数据。临床评估包括康纳斯成人ADHD评定量表（CAARS-S和CAARS-O）、疼痛数字评定量表、医院焦虑抑郁量表和疼痛灾难化量表。使用对ADHD有效的药物（哌甲酯、托莫西汀、胍法辛、阿立哌唑、文拉法辛和度洛西汀）进行基于算法的药物治疗。
13例患者（92.9%）被诊断为ADHD，其中57.2%表现出临界或临床水平症状。在完成基于算法治疗的10例患者中，所有临床量表均观察到具有临床意义的改善。脑灌注SPECT显示，90%的病例额叶灌注不足，膝周前扣带回皮质、岛叶皮质、后扣带回和楔前叶灌注过度，治疗后有所改善。
ADHD在难治性BMS患者中经常共病，针对ADHD的药物治疗可能有助于减轻疼痛、认知功能障碍和脑灌注异常。这些发现表明，ADHD筛查、诊断以及涉及精神科医生的多学科管理可能在优化BMS患者的临床结局中发挥关键作用。
