Pain and Pain Behavior in Burning Mouth Syndrome: A Pain Diary Study

Aims: To characterize pain related to primary burning mouth syndrome (BMS) in terms of intensity, interference, and distress caused by the pain, as well as factors influencing the pain across a period of 2 weeks, and to study the use of coping and management strategies on a daily basis. Methods: Fifty-two female patients with primary BMS completed a 2-week pain diary. Pain intensity, interference, distress, and mood on a 0 to 10 numeric rating scale (NRS), as well as pain amplifying and alleviating factors, were recorded three times a day. The use of treatments (medication or other means) and coping strategies were recorded at the end of each day. Coefficient of variation, repeated measures analysis of variance, and correlative methods were used to assess the between- and within-subject variation, pain patterns, and associations between various pain scores. Results: The overall mean pain intensity score of the 14 diary days was 3.1 (SD: 1.7); there was considerable variation in pain intensity between patients. Most patients experienced intermittent pain. On average, pain intensity increased from the morning to the evening. Intercorrelations between pain intensity, interference, distress, and mood were high, varying between rs = .75 and rs = .93 (P < .001). Pungent or hot food or beverages, stress, and tiredness were the most frequently mentioned pain-amplifying factors. The corresponding pain-alleviating factors were eating, sucking pastilles, drinking cold beverages, and relaxation. Thirty (58%) patients used pain medication and 35% reported using other means to alleviate their BMS pain. There was large variation in the use of coping strategies -between subjects. Conclusion: There were considerable differences in pain, in factors influencing the pain, and in pain behavior across BMS patients. This indicates that patient information and education as well as treatment of BMS pain should be individualized.

burning mouth syndrome; pain behavior; pain coping; pain diary; stomatodynia

1. Zakrzewska JM. The burning mouth syndrome remains an enigma. Pain 1995;62:253–257.

2. Woda A, Pionchon P. A unified concept of idiopathic orofacial pain: Clinical features. J Orofac Pain 1999;13:172–184.

3. Scala A, Checchi L, Montevecchi M, Marini I. Update on burning mouth syndrome: Overview and patient management. Crit Rev Oral Biol Med 2003;14:275–291.

4. Forssell H, Jääskeläinen S, Tenovuo O, Hinkka S. Sensory dysfunction in burning mouth syndrome. Pain 2002;99:41–47.

5. Lauria G, Majorana A, Borgna M, et al. Trigeminal small-fiber sensory neuropathy causes burning mouth syndrome. Pain 2005;115:332–337.

6. Yilmaz Z, Renton T, Yiangou Y, et al. Burning mouth syndrome as a trigeminal small fibre neuropathy: Increased heat and capsaicin receptor TRPV1 in nerve fibres correlates with pain score. J Clin Neurosci 2007;14:864–871.

7. Penza P, Majorana A, Lombardi R, et al. “Burning tongue” and “burning tip”: The diagnostic challenge of the burning mouth syndrome. Clin J Pain 2010;26:528–532.

8. Aaron LA, Turner JA, Mancl LA, Sawchuk CN, Huggins KH, Truelove EL. Daily pain coping among patients with chronic temporomandibular disorder pain: An electronic diary study. J Orofac Pain 2006;20:125–137.

9. Brister H, Turner JA, Aaron LA, Mancl L. Self-efficacy is associated with pain, functioning, and coping in patients with chronic temporomandibular disorder pain. J Orofac Pain 2006;20:115–124.

10. Lynge Pedersen AM, Smidt D, Nauntofte B, Jerlang Christiani C, Bjornsson Jerlang B. Burning mouth syndrome: Etiopathogenic mechanisms, symptomatology, diagnosis and therapeutic approaches. Oral Biosci Med 2004;1:3–19.

11. Lopez-Jornet P, Camacho-Alonso F, Lucero-Berdugo M. Quality of life in patients with burning mouth syndrome. J Oral Pathol Med 2008;37:389–394.

12. Ni Riordain R, Moloney E, O’Sullivan K, McCreary C. Burning mouth syndrome and oral health-related quality of life: Is there a change over time? Oral Diseases 2010;16:643–647.

13. Grushka M. Clinical features of burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:30–36.

14. Grushka M, Sessle BJ, Miller R. Pain and personality profiles in burning mouth syndrome. Pain 1987;28:155–167.

15. van der Ploeg HM, van der Waal N, Eijkman MAJ. Psychological aspects of patients with burning mouth syndrome. Oral Surg Oral Med Oral Pathol 1987;63:664–668.

16. Lamey P-J, Lamb AB. Prospective study of aetiological factors in burning mouth syndrome. Br Med J 1988; 296:1243–1246.

17. Eli I, Baht R, Littner MM, Kleinhauz M. Detection of psychopathological trends in glossodynia patients. Psychosom Med 1994;56:389–394.

18. Svensson P, Kaaber S. General health factors and denture function in patients with burning mouth syndrome and matched controls. J Oral Rehabil 1995;22:6887–6895.

19. Bergdahl M, Bergdahl J. Burning mouth syndrome: Prevalence and associated factors. J Oral Pathol Med 1999;28:350–354.

20. Carlson CR, Miller CS, Reid KI. Psychosocial profiles of patients with burning mouth syndrome. J Orofac Pain 2000;14:59–64.

21. Litt MD, Shafer D, Napolitano C. Momentary mood and coping processes in TMD pain. Health Psychol 2004;23:354–362.

22. van Grootel RJ, van der Glas HW, Buchner R, de Leeuw JRJ. Patterns of pain variation related to myogenous temporomandibular disorders. Clin J Pain 2005;21:154–165.

23. Lewandowski AS, Palermo TM, Kirchner HL, Drotar D. Comparing diary and retrospective reports of pain and activity restriction in children and adolescents with chronic pain conditions. Clin J Pain 2009;25:299–306.

24. Chiros C, O’Brien WH. Acceptance, appraisals, and coping in relation to migraine headache: An evaluation of interrelationships using daily diary methods. J Behav Med 2011;34:307–320.

25. Ketovuori H, Pöntinen PJ. A pain vocabulary in Finnish. The Finnish pain questionnaire. Pain 1981;11:247–253.

26. Stone AA, Neale JM. New measure of daily coping: Development and preliminary results. J Pers Soc Psychol 1984;46:892–906.

27. Affleck G, Urrows S, Tennen H, Higgins P, Abeles M. Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromyalgia. Pain 1996;68:363–368.

28. Taiminen T, Kuusalo L, Lehtinen L, et al. Psychiatric (axis

I) and personality (axis II) disorders in patients with burning mouth syndrome and atypical facial pain. Scand J Pain 2011;2:155–160.

29. Bergdahl J, Anneroth G, Perris H. Personality characteristics of patients with resistant burning mouth syndrome. Acta Odontol Scand 1995;53:7–11.

30. van den Brink M, Bandell-Hoekstra EN, Abu-Saad HH. The occurrence of recall bias in pediatric headache: A comparison of questionnaire and diary data. Headache 2001;41:11–20.

31. Zautra A, Smith B, Affleck G, Tennen H. Examinations of chronic pain and affect relationships: Applications of a dynamic model of affect. J Consult Clin Psychol 2001; 69:786–795.

32. Svensson P, Baad-Hansen L, Arima T. Association of orofacial pain conditions and sleep disturbance. In: Lavigne G, Cistulli PA, Smith MT (eds). Sleep Medicine for Dentists: A Practical Overview. Chicago: Quintessence, 2009:167–174.

33. Zilli C, Brooke RI, Lau CL. Screening for psychiatric illness in patienst with oral dysesthesia by means of general health questionnaire-twenty-eight item verion (GHQ-28) and the irritability, depression and anxiety scale (IDA). Oral Surg Oral Med Oral Pathol 1989;67:384–389.

34. Gremeau-Richard C, Dubray C, Aublet-Cuvelier B, Ughetto S, Woda A. Effect of lingual nerve block on burning mouth syndrome (stomatodynia): A randomized crossover trial. Pain 2010;149:27–32.

35. Bluth FM, March LM, Nicholas MK, Cousins MJ. Self- management of chronic pain: A population-based study. Pain 2005;113:285–292.

36. Gremeau-Richard C, Woda A, Navez ML, et al. Topical clonazepam in BMS: A randomized placebo-controlled study. Pain 2004;108:51–57.

37. Zakrzewska JM, Forssell H, Glenny AM. Interventions for the treatment of burning mouth syndrome. Cochrane Database of Systematic Reviews 2005, issue 1. Art. No.: CD002779. DOI: 10.1002/14651858.CD002779.pub2.

38. Forssell H, Svensson P. Atypical facial pain and burning mouth syndrome. In: Cervero F, Jensen TS (eds). Hand- book of Clinical Neurology, vol 81. Amsterdam: Elsevier, 2006:597–608.

39. Greenspan JD, Craft RM, LeResche L, et al. Studying sex and gender differences in pain and analgesia: A consensus report. Pain 2007;132(suppl 1):S26–S45.

40. Lamey P-J, Freeman R, Eddie S-A, Pankhurst C, Rees T. Vulnerability and presenting symptoms in burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:48–54.

41. Mignogna MD, Pollio A, Fortuna G, et al. Unexplained somatic comorbidities in patients with burning mouth syndrome: A controlled clinical study. J Orofac Pain 2011;25:131–140.