The evaluation of psychological factors in burning mouth syndrome

Burning mouth syndrome (BMS) is chronic orofacial pain characterized by a burning sensation of the healthy oral mucosa. The condition usually occurs in middle-aged and elderly women (peri and post- menopausal period). The etiology of BMS remains unknown and probably is the result of interactions among local, systemic, and psychological factors. Several studies suggest a strong relationship between psychological factors and burning symptoms, although it is still unclear whether the psychological factors are the cause or result of burning symptoms. The most common psychological factors associated with burning symptoms are somatoform pain disorder, depression, anxiety, and stressful life events. The aim of this study was to evaluate the psychological status of BMS patients to determine whether psychological factors are related to burning symptoms. In a cross-sectional study, 30 female patients with BMS were included along with 27 healthy individuals as controls. Inclusion criteria for BMS patients were burning sensation in healthy oral mucosa, and absence of systemic and local ethological factors associated with a burning sensation. Similar inclusion criteria were considered for the control group without any oral complaints. Burning severity was assessed by a 10 cm visual analog scale (VAS) and the severity of somatic symptoms was evaluated by Patient Health Questionnaire-15 (PHO-15). The severity of anxiety, depression, and catastrophizing in pain was determined by the Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pain Catastrophizing Scale (PCS). A Mamp-Whitney U test and correlations (Spearman's correlation coefficient) were used to compare the groups. The sample consisted of 57 participants, all women with a mean age of 57 (57.807=11.463). The overall mean daily pain intensity score was 5.9+1.9 (VAS). The results show that BMS patients had significantly higher scores in somatization (p=0.001) than the control group. PHQ-15 scale in individuals with BMS (+SE for mean) was 3.23+3.26 and in individuals without BMS was 6.44+3.784. No significant differences were found in anxiety scores (GAD- 7 ; p=0.944), depression scores (PHQ- 9 ; p=0.955), and catastrophizing scores (PCS ; p=0.741). There was no statistically significant correlation between the severity of burning and psychological factors assessed by PHQ-15 (p=0.851), GAD-7 (p=0.421), PHQ-9 (p=0.340), and PCS (p=0.463). The present findings indicate that BMS patients had distinct differences in somatosensory function and high somatization scores may imply that vulnerable BMS patients experience emotional distress as pain.