تسبب متلازمة الفم المحترق ألم حرقة فموية مستمراً قد يكون مقاوماً للعلاج الأولي. عندما لا يوفر النظام العلاجي الخطي الأول المعتمد على حمض الليبويك ألفا أو عوامل مضادات الاختلاج تخفيفاً كافياً للألم، تصبح مجموعة مختلفة من التدخلات البديلة ذات صلة.
فشل العلاج الخطي الأول بـ حمض الليبويك ألفا أو خيارات مضادات الاختلاج (بما في ذلك جابابنتين وبريجابالين) في تحقيق أهداف العلاج: انخفاض ملموس في ألم الحرقة الفموية على مقياس VAS، أو فائدة مستدامة في التقييم طويل الأمد لأكثر من ثلاثة أشهر.
تقليل ألم الحرقة الفموية، ويُقيَّم بمقاييس الألم المعتمدة (درجة VAS/VNS).
Catuama shows promising VNS (0–10) score reduction results compared to placebo with a minimal adverse effect of sleep alteration observed in the study (SMD 0.68, 95% CI 1.21 to 0.16).
At the end of 12 weeks of therapy, there was a reduction in the number of oral mucosa burning sites and improved ability to cope with the burning pain, there was no statistically significant difference with the placebo group (SMD 0.23, 95% CI 0.87 to 0.41).
Ottaviani et al. revealed a short-term (60 days) benefit with 1200 mg/day umPEA in BMS patients (SMD 0.70, 95% CI 1.39 to 0.01) but declining pain relief at 4 months (SMD 0.26, 95% CI 0.94 to 0.41) compared to placebo group.
Administration of 100 mg trazodone daily for the first 4 days followed by 200 mg for 8 weeks significantly decreased patients' VNS pain intensity against baseline (MD 13.9, p < 0.01), but there was no significant difference with the placebo group (SMD 0.06, 95% CI 0.72 to 0.59; RR 0.95, 95% CI 0.61–1.49).
The use of citalopram 10 mg daily followed by an increment to 20 mg after 1 week showed an improvement of VAS score of 87.45% (MD: 7.8, p < 0.001).
Crocin showed a significant reduction in VAS score (MD 7.8, p < 0.001) and has a similar improvement 87.5% of burning mouth score as citalopram.
A cross-over clinical trial involving intervention with a high melatonin dosage (12 mg/day) did not provide pain relief (SMD 0.24, 95% CI 0.39 to 0.87; RR 1.18, 95% CI 0.31–4.43) and sleep score improvement compared to placebo.
A combination of topical spray and swallowing of 900 ppm LVO daily for 12 weeks led to a significant reduction in the median pain score (MD 3.0, p < 0.001) and burning (MD 1.0, p = 0.003) compared to baseline, but there was no significant difference (p = 0.99) when compared with the placebo group.
Ten days of 30,000 pulses of rTMS therapy over the left GDLPFC significantly reduced VAS score (MD: 3.1, p = 0.002) with 75% of patients reporting a decrease in pain intensity of more than 50% compared to baseline.
The hypothesis of wearing the tongue protector to prevent continuous irritation of tongue on teeth or denture has a statistically significant difference in improvement in VAS score between wearer (MD 3.6) and non-wearer with habitual avoidance reminder (MD 1.4, p < 0.001; SMD 1.15, 95% CI 1.76 to 0.54).
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