Grushka M, Epstein J, Mott A
School of Dentistry, Case Western Reserve University.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Nov;86(5):557-61. doi: 10.1016/s1079-2104(98)90345-6.
Current treatment for burning mouth syndrome is usually directed at correction of detected organic causes or is empiric, and it often involves the use of tricyclic antidepressants. Recently, there has been renewed interest in the use of benzodiazepines for burning mouth syndrome. The present study was designed to assess the effect of clonazepam in burning mouth syndrome.
Thirty patients, each with a chief complaint of mouth burning without oral mucosal lesions, were entered into the study. All patients underwent routine blood screens. Identified abnormalities were corrected, when possible, before clonazepam was prescribed. The starting dose was 0.25 mg daily, with an increase in dose of 0.25 mg on a weekly basis if symptoms continued.
The subject population consisted of 29 women and 1 man. All subjects had been symptomatic (average premorbid burning intensity, 7.0 +/- 1.9 on 10-point scale) for 1 month to 12 years (mean, 3.9 +/- 3.4 years; median, 2.75 years), and 16% had had burning for more than 2 years. Three groups of patients were identified: those who experienced partial to complete relief with clonazepam and who were using the medication at the last follow-up (group 1; 43%); those who found the clonazepam helpful but withdrew from the medication because of side effects--usually drowsiness (group 2; 27%); and those who did not benefit from clonazepam (group 3; 30%). Among the 3 groups, age was found to be significantly lower for group 1 than for group 2 but not significantly lower for group 1 than for group 3. Although the difference did not reach significance, the mean dose of clonazepam appeared lower for group 1 patients than for the other 2 patient groups. The number of patients with burning for less than 2 years was larger in group 1 than in the other groups.
The results suggest that clonazepam may be helpful in burning mouth syndrome, inasmuch as 70% of patients (groups 1 and 2) experienced pain reduction with effects at low doses. These findings suggest that the mechanism of action of clonazepam may be specific and separate from the anxiolytic effect of the benzodiazepines and that clonazepam may represent a useful therapy in a subset of patients with burning mouth syndrome. Double-blind, placebo-controlled trials are warranted.
灼口综合征目前的治疗通常针对已发现的器质性病因进行纠正或采用经验性治疗，且常涉及使用三环类抗抑郁药。最近，苯二氮䓬类药物用于灼口综合征的治疗又重新引起了人们的兴趣。本研究旨在评估氯硝西泮对灼口综合征的疗效。
30例以口腔灼痛为主诉且无口腔黏膜病变的患者纳入本研究。所有患者均接受了常规血液检查。在开氯硝西泮之前，尽可能纠正已发现的异常情况。起始剂量为每日0.25毫克，若症状持续，每周增加剂量0.25毫克。
研究对象包括29名女性和1名男性。所有受试者均有症状（病前平均灼痛强度，10分制下为7.0±1.9），症状持续时间为1个月至12年（平均3.9±3.4年；中位数2.75年），16%的患者灼痛超过2年。确定了三组患者：在最后一次随访时使用氯硝西泮且疼痛部分或完全缓解的患者（第1组；43%）；发现氯硝西泮有帮助但因副作用（通常为嗜睡）而停药的患者（第2组；27%）；未从氯硝西泮中获益的患者（第3组；30%）。在这三组中，发现第1组患者的年龄显著低于第2组，但第1组与第3组相比年龄降低不显著。虽然差异未达到显著水平，但第1组患者氯硝西泮的平均剂量似乎低于其他两组患者。灼痛少于2年的患者在第1组中的人数多于其他组。
结果表明氯硝西泮可能对灼口综合征有帮助，因为70%的患者（第1组和第2组）疼痛减轻且低剂量有效。这些发现表明氯硝西泮的作用机制可能是特异性的，与苯二氮䓬类药物的抗焦虑作用不同，且氯硝西泮可能是灼口综合征部分患者的一种有效治疗方法。有必要进行双盲、安慰剂对照试验。
