II. Epidemiology
- Patients are generally older
- More common in women by ratio of 7:1
- Prevalence: 1 million in U.S. affected
III. Pathophysiology
- No clear etiology identified
- Postulated etiologies
- Nutritional Deficiency
- Major Depresion
- Increased Taste Sensation
- Xerostomia
- Menopause (90% of women are postmenopausal)
- Trigeminal Nerve (CN V) Neuropathy
- Candidiasis
- Dentures
- Diabetes Mellitus
IV. Symptoms
- Characteristics of pain
- Burning pain affecting oropharynx
- Pain may be severe Toothache-like pain
- Timing
- Onset in mid-morning
- Progression over course of day
- Peaks in late afternoon
- Subsides at night (may interfere with going to sleep)
- Multiple pain sites often affected
- Anterior two-thirds of Tongue
- Oral Mucosa (especially anterior Hard Palate)
- Lower lip mucosa
- Palliative
- Pain may be relieved with eating
- Provocative
- Worse with emotion, speech
- Associated symptoms
- Dry Mouth (Xerostomia)
- Taste disturbance (bitter or Metallic Taste)
V. Signs
- No lesions present
VI. Differential Diagnosis
- See Tongue Pain
VII. Labs
- Complete Blood Count
- Serum Iron or Ferritin
- Serum Vitamin B12
- Zinc
- KOH and Fungal Culture
- Serum Glucose or Hemoglobin A1C
VIII. Associated Conditions
- Mood disturbance including Major Depression
IX. Course
- Spontaneous onset with persistence for years
X. Management
- Treat potential causes of differential diagnosis
- Antifungal agent for Oral Candidiasis (Thrush)
- Estrogen Replacement for Menopause
- B Vitamin Supplementation for B Vitamin Deficiency
- Increase Saliva in Xerostomia
- Neuropathic Pain Medications
- Amitriptyline (Elavil) at bedtime
- Clonazepam (Klonopin) at bedtime
- Gabapentin (Neurontin) at bedtime
- Capsaicin
- Start with hot pepper diluted 1:2 with water
- Rinse mouth with 1 teaspoon
- May decrease dilution to 1:1 as tolerated