COMPARISON BETWEEN THERAPY WITH ACUPUNCTURE AND PHARMACOTHERAPY WITH CLONAZEPAM IN PATIENTS WITH BURNING MOUTH SYDNROME

Abstract

Sindrom pekućih usta (SPU) je kronični oralni symptom karakteriziran osjećajem pečenja u osoba koje imaju klinički zdrav izgled oralne sluznice. Čini se da je u podlozi neuropatološki poremećaj. Nadalje, postoji manjak randomiziranih kontroliranih istraživanja s obzirom na postojeće liječenje ovog sindroma. U ispitivanje je bilo uključeno 60 bolesnika (6 muškaraca i 54 žene) sa sindromom primarnog sindroma pekućih usta kao i 20 kontrolnih ispitanika koje su liječeni na Klinici za neurologiju zbog tegoba od strane slabinske kralježnice. Ispitanici su nakon postavljanja dijagnoze sindroma pekućih usta, podijeljeni u tri skupine po dvadeset ispitanika kod kojih će se primijeniti terapija klonazepamom, terapija akupunkturom i grupa ispitanika bez terapije (kontrolna skupina). Ispitanici su prije dobivanja bilo koje od terapija (klonazepam, akupunktura, kontrolna skupina) ispunili upitnike VAS, Lanssova skala, MoCa, SF-36, Hamiltonova skala, Beckova skala. Iste upitnike su ispunili i nakon završetka bilo koje od terapija. Svrha istraživanja je bila: ustanoviti učinkovitost akupunkture i klonazepama u oboljelih od sindroma pekućih usta a na temelju rezultata skala (LANSS, VAS, MoCa, SF-36, Beck i Hamilton), te neurološke poremećaje u oboljelih od sindroma pekućih usta. Rezultati ovog istraživanja pokazuju kako je liječenje akupunkturom i kloazepamom dovelo do značajne regresije boli, kao i do regresije anksiodepresivnih tegoba i poboljšanja kvalitete života, dok kod kognitivnih funkcija nije došlo do značajnijih promjena. U rezultatima vidnih evociranih potencijala nije nađeno značajnijih odstupanja od normale, analizom tremora također nije nađeno značajnijih odstupanja od normalnih vrijednosti. Zabilježena je statistički značajna pojavnost disfunkcije u EMNG-u refleksu treptaja uz promjenu habituacije R2 komponente i pozitivnu R3 komponentu, također je u vrijednostima V-R latence u BAERU zabilježeno produljenje latence što ukazuje na disfunkciju u inervacijskom području n trigeminusa. Iz istraživanja se dade zaključiti kako su akupuntkura i klonazepam učinkoviti u liječenju sindroma pekućih usta.Background and objectives: Burning mouth syndrome (BMS) is a chronic oral symptom with burning sensation and clinically healthy appearance of the oral mucosa. Recently, neuropathological basis has been provided to support this concept. Furthermore, there is a lack of randomized controlled studies regarding applied therapies. Therefore, the aim of this study was to compare the effectiveness of acupuncture and clonazepam in patients with burning mouth syndrome measured by the following scales (LANSS, VAS, MoCa, SF-36, Beck i Hamilton), to determine a correlation between temporomandibular disturbances and BMS as well as to establish a correlation between neurological disturbances and BMS. Methods: This study included 60 patients with BMS (6 men and 54 women) and 20 controls with low back painful disturbances. BMS patients were randomly divided into three groups: 20 patients who took clonazepam, 20 patients who underwent acupuncture treatment and 20 subjects without any therapies. Prior to and after any therapies the subjects were asked to rate pain severity on the following scales: VAS, LANSS, MoCa, SF-36, Hamilton, and Beck. The analysis of temporomandibular disturbances was made by clinical examination and x-ray. Neurological tests included brain evoked auditory and eye potentials (BAEP), electromyoneurography of the blink reflex. Statistical analysis was performed by use of Student t test and logistic regression analysis. P values lower than 0.05 were considered significant. Results: The results of this study showed that both acupuncture and clonazepam led to a significant elimination of pain as well as anxio-depressive symptoms and, also, to improvement in quality of life in BMS patients. However, there was no improvement in cognitive function. There was no significant assignation in evoked eye potentials as well as in tremor analysis. There was a significant dysfunction seen electromyographically of the blink reflex with changed habituation of R2 component and positive R3 component as well as an increased V-R latency in BAEP, which implies a dysfunction of the innervation area of the trigeminal nerve. Conclusion: Acupuncture and clonazepam are similarly effective for patients with burning mouth syndrome