51. Are the Effects of Amitriptyline and Aripiprazole on Pain Catastrophizing in Patients with Burning Mouth Syndrome Associated with Changes in QTc and Prolactin Levels?
- Author
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Chizuko Maeda, Takahiko Nagamine, Chihiro Takao, Risa Tominaga, Yasuyuki Kimura, Motoko Watanabe, and Akira Toyofuku
- Abstract
Background: Burning mouth syndrome (BMS) is an intractable chronic pain disorder of unknown cause characterized by burning sensation without any organic abnormality in the oral mucosa. In a chronic pain disorder such as BMS, the ability to control pain catastrophizing that accompany the pain determines the outcome of treatment. Pain catastrophizing is associated with the dopamine nervous system and can be quantitatively assessed with the Pain Catastrophizing Scale (PCS). Treatment options include antidepressants, benzodiazepines, antipsychotics, anticonvulsants, analgesics, hormone replacement therapy, and psychotherapy, with antidepressants being the most commonly used and effective. Methods: We analyzed whether amitriptyline and aripiprazole, typical drug therapies for BMS patients, improve PCS using a 2-year case series from our department. We also examined whether changes in QTc and serum prolactin levels were associated with improvement in PCS as an indicator of the efficacy of these monoamine modulators. Results: Both amitriptyline and aripiprazole statistically significantly improved PCS. Amitriptyline increased heart rate and mildly shortened QTc, while aripiprazole did not alter heart rate or QTc. Both amitriptyline and aripiprazole caused very mild increases in prolactin levels. Only prolonged QTc in the aripiprazole group correlated with improved PCS. Discussion and Conclusions: Monoamine-targeted pharmacotherapy for BMS is effective against pain catastrophizing in patients with BMS. Since the dopaminergic nervous system is primarily involved in pain catastrophizing, a mild increase in prolactin levels was therefore found to be associated with efficacy. However, changes in prolactin levels were not predictive of individual treatment response. The anticholinergic effects of amitriptyline on QTc and prolactin may have prevented these markers from predicting treatment response at the individual level. Only prolonged QTc in the aripiprazole group was correlated with efficacy. Aripiprazole has no anticholinergic effects and dopamine stability was observed at QTc, but its agonist effect on prolactin on pituitary cells may not have been a marker of its effect on pain catastrophizing. [ABSTRACT FROM AUTHOR]
- Published
- 2023