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Therapeutic Dose of Amitriptyline for Older Patients with Burning Mouth Syndrome

Authors Suga T, Takenoshita M, Watanabe T, Tu TTH, Mikuzuki L, Hong C, Miura K, Yoshikawa T, Nagamine T, Toyofuku A

Received 22 October 2019

Accepted for publication 13 December 2019

Published 30 December 2019 Volume 2019:15 Pages 3599—3607


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Taro Kishi

Takayuki Suga,1 Miho Takenoshita,1 Takeshi Watanabe,1 Trang TH Tu,1 Lou Mikuzuki,1 Chaoli Hong,1 Kazuhito Miura,2 Tatsuya Yoshikawa,1 Takahiko Nagamine,3 Akira Toyofuku1

1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Gerodontology, Division of Oral Health Science, Graduate School of Dental Medicine, Hokkaido University, Hokkaido, Japan; 3Department of Psychiatric Internal Medicine, Sunlight Brain Research Center, Yamaguchi, Japan

Correspondence: Akira Toyofuku
Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan
Tel/Fax +81 3 5803 5898

Objective: To assess the therapeutic dose and safety of amitriptyline and the outcome following treatment with amitriptyline among older patients with burning mouth syndrome (BMS).
Methods: 187 consecutive patients were prescribed amitriptyline as a first-line medication from April 2016 to September 2018 and followed-up for >1 month. Patients were divided into 3 groups: group 1, 113 patients aged <65 years; group 2, 52 patients aged between 65 and 74 years; and group 3, 22 patients aged 75 years or older. The visual analog scale (VAS), Pain Catastrophizing Scale (PCS), Somatic Symptom Scale-8 (SSS-8), Patient Global
Impression of Change (PGIC), and Short-form McGill Pain Questionnaire (SF-MPQ) were used for analysis.
Results: Thirty-two patients (17 in group 1, 10 in group 2, and 5 in group 3) stopped taking amitriptyline due to side effects. There were no differences among the groups with respect to sex; scores of VAS, PCS, and SSS-8; and drop-out ratio. There were no significant differences in the VAS, PCS, and PGIC scores among the groups after 1 month. The mean daily dose after 1 month was 20.4 ± 8.6 mg in group 1, 17.3 ± 8.7 mg in group 2, and 13.2 ± 5.8 mg in group 3; this difference was significant (p value = 0.003). About 76% of patients showed improvements in their symptoms (PGIC ≥ 3). About 90% of patients reported side effects. No serious side effects occurred.
Conclusion: The therapeutic dose of amitriptyline may be lower for older BMS patients than for younger patients.

Keywords: amitriptyline, burning mouth syndrome, aged, chronic pain

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