Associations between pain, anxiety and depression and mindfulness in patients with burning mouth syndrome: a cross-sectional study

Background: Burning mouth syndrome (BMS) is a chronic pain disorder affecting the oral mucosa, often accompanied by psychological comorbidities. Higher levels of mindfulness have been associated with reduced pain and fewer emotional symptoms in some chronic pain conditions, but its role in BMS remains inadequately explored. Methods: 146 patients diagnosed with BMS, according to the International Classification of Orofacial Pain, 1st edition, were recruited from the Department of Oral Medicine at a stomatology hospital. Mindfulness, pain intensity and psychological symptoms were assessed using the Five Facet Mindfulness Questionnaire, visual analog scale, and self-report screening tools, respectively. Spearman’s correlation and multiple regression analyses were conducted to evaluate the relationships between mindfulness and levels of pain, anxiety, and depression. Results: Mindfulness showed significant negative correlations with pain (r = −0.204, p < 0.05), anxiety (r = −0.309, p < 0.01), and depression (r = −0.299, p < 0.01). After controlling for confounding variables, higher overall mindfulness remained significantly associated with lower pain intensity (β = −0.268, p < 0.05), although the associations with anxiety and depression were no longer statistically significant (p > 0.05). Among the mindfulness facets, higher scores on the “describing” facet were associated with reduced pain intensity (β = −0.231, p < 0.05). Additionally, higher scores on the “non-judging” (Odds Ratio (OR) = 0.871, p < 0.05) and “non-reactivity” (OR = 0.869, p < 0.05) facets were associated with fewer anxiety symptoms, while the “acting-with-awareness” facet was significantly associated with fewer depressive symptoms (OR = 0.869, p < 0.05). Conclusions: The overall mindfulness level and the “describing” facet appear to be associated with pain severity, whereas the “non-judging” and “non-reactivity” facets are related to anxiety symptoms, and the “acting-with-awareness” facet is linked to depressive symptoms, suggesting that mindfulness-based interventions may offer a beneficial approach in the management of BMS.

Burning mouth syndrome; Mindfulness; Pain; Anxiety; Depression

[1] Lee B, Park JW, Jo JH, Oh B, Chung G. Comparative analysis of the oral microbiome of burning mouth syndrome patients. Journal of Oral Microbiology. 2022; 14: 2052632.

[2] International classification of orofacial pain, 1st edition (ICOP). Cephalalgia. 2020; 40: 129–221.

[3] Wu S, Zhang W, Yan J, Noma N, Young A, Yan Z. Worldwide prevalence estimates of burning mouth syndrome: a systematic review and meta‐analysis. Oral Diseases. 2022; 28: 1431–1440.

[4] Brauwers KG, Bueno VM, Calcia TBB, Daroit NB. Sexual hormones changes in burning mouth syndrome: a systematic review. Journal of Oral Rehabilitation. 2024; 51: 2475–2483.

[5] Chen Q, Shi Y, Jiang L, Zhou Y, Dan H, Jin X, et al. Management of burning mouth Syndrome: a position paper of the Chinese Society of Oral Medicine. Journal of Oral Pathology & Medicine. 2020; 49: 701–710.

[6] Yoshino A, Otsuru N, Doi M, Maekawa T, Sasaoka T, Yamawaki S. Interoceptive accuracy is related to the psychological mechanisms of the burning mouth syndrome: a cross-sectional study. BMC Oral Health. 2022; 22: 297.

[7] Mao F, Cai L, Pan D, Huang M, Wang Q, Chen Q, et al. Burning mouth syndrome may essentially be related to psychoneuroimmunology: mechanism hypothesis. Journal of Oral Rehabilitation. 2025; 52: 199–207.

[8] Galli F, Lodi G, Sardella A, Vegni E. Role of psychological factors in burning mouth syndrome: a systematic review and meta-analysis. Cephalalgia. 2017; 37: 265–277.

[9] Karamat A, Smith JG, Melek LNF, Renton T. Psychologic impact of chronic orofacial pain: a critical review. Journal of Oral & Facial Pain and Headache. 2022; 36: 103–140.

[10] Pereira JV, Normando AGC, Rodrigues-Fernandes CI, Rivera C, Santos-Silva AR, Lopes MA. The impact on quality of life in patients with burning mouth syndrome: a systematic review and meta-analysis. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2021; 131: 186–194.

[11] Oguchi M, Nicholas MK, Asghari A, Sanders D, Wrigley PJ. Psychologically based interventions for adults with chronic neuropathic pain: a scoping review. Pain Medicine. 2024; 25: 400–414.

[12] Brandel MG, Lin C, Hennel D, Khazen O, Pilitsis JG, Ben-Haim S. Mindfulness meditation in the treatment of chronic pain. Neurosurgery Clinics of North America. 2022; 33: 275–279.

[13] Biao D, Umoh K, Qiguang C, Xiaole W, Ting F, Yuqian Y, et al. The role of mindfulness therapy in the treatment of chronic pain. Current Pain and Headache Reports. 2024; 28: 1155–1165.

[14] Paschali M, Lazaridou A, Sadora J, Papianou L, Garland EL, Zgierska AE, et al. Mindfulness-based interventions for chronic low back pain: a systematic review and meta-analysis. The Clinical Journal of Pain. 2024; 40: 105–113.

[15] Merrill RL, Goodman D. Chronic orofacial pain and behavioral medicine. Oral and Maxillofacial Surgery Clinics of North America. 2016; 28: 247–260.

[16] Ganesan A, Gauthaman J, Kumar G. The impact of mindfulness meditation on the psychosomatic spectrum of oral diseases: mapping the evidence. Journal of Lifestyle Medicine. 2022; 12: 1–8.

[17] Schumer MC, Lindsay EK, Creswell JD. Brief mindfulness training for negative affectivity: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology. 2018; 86: 569–583.

[18] Harper L, Jones A, Goodwin L, Gillespie S. Association between trait mindfulness and symptoms of post-traumatic stress: a meta-analysis. Journal of Psychiatric Research. 2022; 152: 233–241.

[19] Mattes J. Systematic review and meta-analysis of correlates of FFMQ mindfulness facets. Frontiers in Psychology. 2019; 10: 2684.

[20] Pincock JS, Terrill AL. Association of mindfulness to resilience, anxiety, and depressive symptoms after spinal cord injury—a correlational study. Spinal Cord Series and Cases. 2020; 6: 7.

[21] Azizi Z, Jandaghi G, Firoozi M, Zia-Tohidi A, Ebnerasouli S. The relative importance of mindfulness facets and their interactions: relations to psychological symptoms in chronic pain. Mindfulness. 2022; 13: 1054–1068.

[22] Greenberg J, Bakhshaie J, Lovette BC, Vranceanu AM. Association between coping strategies and pain-related outcomes among individuals with chronic orofacial pain. Journal of Pain Research. 2022; 15: 431–442.

[23] Greenberg J, Spyropoulos DC, Bakhshaie J, Vranceanu A. Mindfulness facets associated with orofacial pain outcomes. Journal of Integrative and Complementary Medicine. 2022; 28: 839–844.

[24] Melchior MDO, Magri LV, Victoria Díaz‐Serrano K, Leite‐Panissi CRA, Gherardi‐Donato ECS. How do the mindfulness and sensory‐behavioural‐emotional aspects influence the painful experience related to temporomandibular disorder? Journal of Oral Rehabilitation. 2024; 51: 1175–1183.

[25] Nosratzehi T, Payandeh A, DehYadegari F. The complaints, type, and severity of stressful events in patients with burning mouth syndrome referring to Zahedan school of dentistry, Iran. Clinical, Cosmetic and Investigational Dentistry. 2020; 12: 123–130.

[26] Canfora F, Calabria E, Pecoraro G, D’Aniello L, Aria M, Marenzi G, et al. The use of self‐report questionnaires in an analysis of the multidimensional aspects of pain and a correlation with the psychological profile and quality of life in patients with burning mouth syndrome: a case‐control study. Journal of Oral Rehabilitation. 2022; 49: 890–914.

[27] Tan HL, Smith JG, Hoffmann J, Renton T. A systematic review of treatment for patients with burning mouth syndrome. Cephalalgia. 2022; 42: 128–161.

[28] Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006; 166: 1092–1097.

[29] Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999; 282: 1737–1744.

[30] Ong CW, Pierce BG, Klein KP, Hudson CC, Beard C, Björgvinsson T. Longitudinal measurement invariance of the PHQ-9 and GAD-7. Assessment. 2022; 29: 1901–1916.

[31] Stochl J, Fried EI, Fritz J, Croudace TJ, Russo DA, Knight C, et al. On dimensionality, measurement invariance, and suitability of sum scores for the PHQ-9 and the GAD-7. Assessment. 2022; 29: 355–366.

[32] Chana P, Smith JG, Karamat A, Simpson A, Renton T. Catastrophising, pain self‐efficacy and acceptance in patients with burning mouth syndrome. Journal of Oral Rehabilitation. 2021; 48: 458–468.

[33] Zeng Y, Xiao J, Zhang Q, Liu X, Ma A. Prevalence and factors associated with anxiety and depression among Chinese prison officers during the prolonged COVID-19 pandemic. Frontiers in Public Health. 2023; 11: 1218825.

[34] Shi Q, Ding J, Su H, Du Y, Pan T, Zhong X. Association of long-term HbA1c variability with anxiety and depression in patients with type 2 diabetes: a cross-sectional retrospective study. Psychology Research and Behavior Management. 2023; 16: 5053–5068.

[35] Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006; 13: 27–45.

[36] Nigol SH, Di Benedetto M. The relationship between mindfulness facets, depression, pain severity and pain interference. Psychology, Health & Medicine. 2020; 25: 53–63.

[37] Poulin PA, Romanow HC, Rahbari N, Small R, Smyth CE, Hatchard T, et al. The relationship between mindfulness, pain intensity, pain catastrophizing, depression, and quality of life among cancer survivors living with chronic neuropathic pain. Supportive Care in Cancer. 2016; 24: 4167–4175.

[38] Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011; 152: S2–S15.

[39] Elvery N, Jensen MP, Ehde DM, Day MA. Pain catastrophizing, mindfulness, and pain acceptance: what’s the difference? The Clinical Journal of Pain. 2017; 33: 485–495.

[40] Ådnøy T, Solem S, Hagen R, Havnen A. An empirical investigation of the associations between metacognition, mindfulness experiential avoidance, depression, and anxiety. BMC Psychology. 2023; 11: 281.

[41] Pleman B, Park M, Han X, Price LL, Bannuru RR, Harvey WF, et al. Mindfulness is associated with psychological health and moderates the impact of fibromyalgia. Clinical Rheumatology. 2019; 38: 1737–1745.

[42] Carpenter JK, Conroy K, Gomez AF, Curren LC, Hofmann SG. The relationship between trait mindfulness and affective symptoms: a meta-analysis of the five facet mindfulness questionnaire (FFMQ). Clinical Psychology Review. 2019; 74: 101785.

[43] Carvajal-Vogtschmidt NM, Romero-Aguilera G. Prevalence of glossodynia. Burning mouth syndrome and associated risk factors in the population of Ciudad Real. Revista de la Sociedad Española del Dolor. 2023; 30: 15–29.

[44] Rudkin E, Medvedev ON, Siegert RJ. The five-facet mindfulness questionnaire: why the observing subscale does not predict psychological symptoms. Mindfulness. 2018; 9: 230–242.

[45] McCracken LM, Morley S. The psychological flexibility model: a basis for integration and progress in psychological approaches to chronic pain management. The Journal of Pain. 2014; 15: 221–234.

[46] Lin X, Jin R, Huang W, Ye Y, Jin J, Zhu W. Trends of burning mouth syndrome: a bibliometric study. Frontiers in Neurology. 2024; 15: 1443817.

[47] Russo M, Crafa P, Guglielmetti S, Franzoni L, Fiore W, Di Mario F. Burning mouth syndrome etiology: a narrative review. Journal of Gastrointestinal and Liver Diseases. 2022; 31: 223–228.

[48] Porporatti AL, Schroder ÂGD, Lebel A, Moreau N, Misery L, Alajbeg I, et al. Is burning mouth syndrome associated with stress? A meta-analysis. Journal of Oral Rehabilitation. 2023; 50: 1279–1315.

[49] Adamo D, Pecoraro G, Fortuna G, Amato M, Marenzi G, Aria M, et al. Assessment of oral health‐related quality of life, measured by OHIP‐14 and GOHAI, and psychological profiling in burning mouth syndrome: a case‐control clinical study. Journal of Oral Rehabilitation. 2020; 47: 42–52.

[50] Alvarenga-Brant R, Costa FO, Mattos-Pereira G, Esteves-Lima RP, Belém FV, Lai H, et al. Treatments for burning mouth syndrome: a network meta-analysis. Journal of Dental Research. 2023; 102: 135–145.

[51] Markham DJ, Davis TS, Oscherwitz ME, Jorizzo JL. A structured approach for the management of orodynia (burning mouth syndrome). Cutis. 2024; 113: 224–225.