Low-dose naltrexone for treatment of burning mouth syndrome

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology Vol. 135; no. 4; pp. e83 - e88
• Main Authors: Sangalli, Linda, Miller, Craig S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Burning Mouth Syndrome - diagnosis; Burning Mouth Syndrome - drug therapy; Burning Mouth Syndrome - etiology; Clonazepam - therapeutic use; Female; Fibromyalgia; Headache; Humans; Middle Aged; Naltrexone - therapeutic use; Pain - complications; Pain - drug therapy
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2022.04.048

The International Classification of Disease defines burning mouth syndrome (BMS) as a chronic intraoral burning sensation, with no identifiable local or systemic cause. Since current management is often unsatisfactory, the aim of this report is to describe a new treatment modality (i.e., low-dose naltrexone [LDN]). A 62-year-old woman presented with the complaint of burning on the tongue of 3 years’ duration. Existing comorbidities were fibromyalgia, irritable bowel syndrome, headache, and interstitial cystitis. Her reported pain intensity ranged from 2/10 (morning) to 8/10 (evening) on a numeric rating scale. With the diagnosis of BMS and hyposalivation, and in light of her current clonazepam use and fibromyalgia, a dry mouth protocol and LDN (3 mg) were prescribed. After 1 month, her pain intensity decreased by 50%, with no pain upon awakening. After 2 months, the widespread pain associated with her chronic morbidities also reduced by 50%, and her headache disappeared. After adjusting LDN dose to 4.5 mg, the patient was stable at 6 months, with 50% reduction of widespread pain and 2/10 BMS pain, and no reported side effects. These preliminary results suggest that LDN may be a feasible and effective treatment for BMS, especially in patients’ refractory to traditional treatment.