Time of Day Influences Psychophysical Measures in Women With Burning Mouth Syndrome.

Janell S Payano Sosa,David A Seminowicz,Joyce T Da Silva,Soo Y Yoo,Michael L Keaser,Shana A B Burrowes,Timothy F Meiller

doi:10.3389/fnins.2021.698164

Abstract

Burning mouth syndrome (BMS) is a chronic orofacial pain condition that mainly affects postmenopausal women. BMS type I patients report little to no spontaneous pain in the morning and increases in pain through the day, peaking in the afternoon. Quantitative sensory testing (QST) findings from BMS type 1 patients are inconsistent as they fail to capture this temporal variation. We examined how QST in BMS type 1 (n = 18) compared to healthy participants (n = 33) was affected by time of day. QST of the face and forearm included warmth detection threshold (WDT), cold detection threshold (CDT), and heat pain thresholds (HPT), ratings of suprathreshold heat, and pressure pain thresholds (PPT), and was performed twice: once in the morning and once in the afternoon. Compared to healthy participants, BMS patients had higher pain sensitivity to phasic heat stimuli at most temperatures (35°C U = 126.5, p = 0.0006, 39°C U = 186.5, p = 0.0386, 41°C U = 187.5, p = 0.0412, 43°C U = 171, p = 0.0167, 45°C U = 168.5, p = 0.0146) on the forearm, but no differences in pain thresholds (HPT and PPT) regardless of time of day or body area tested. BMS patients had higher WDT (U = 123, p = 0.0172), and lower CDT (U = 98, p = 0.0021) of the forearm and lower WDT of the face (U = 55, p = 0.0494). The differences in forearm WDT (U = 71.5, p = 0.0113) and CDT (U = 70, p = 0.0096) were most pronounced in the morning. In summary, BMS type I patients had increased pain sensitivity on the forearm, but no differences in pain thresholds on the face or forearm. Patients also showed altered thermal sensitivity, which depended on body area tested (heightened in the orofacial region but blunted on the forearm), and was more pronounced in the morning plausibly due to hypervigilance.

Highlights

Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition that mainly affects postmenopausal women (Grushka et al, 1987; Lipton et al, 1993; Albuquerque et al, 2006; Bergdahl and Bergdahl, 2007; Rivinius, 2009; Dahiya et al, 2013)
We focus on Burning mouth syndrome (BMS) type I because patients experience little to no pain in the morning and as the day progresses their pain increases peaking in the afternoon (Lamey, 1996; Abetz and Savage, 2009)
We investigated whether sensory sensitivity of the orofacial region and the forearm was affected by time of day and the presence of ongoing pain in BMS type I patients compared to healthy participants

Summary

Introduction

Burning Mouth Syndrome (BMS) is a chronic orofacial pain condition that mainly affects postmenopausal women (Grushka et al, 1987; Lipton et al, 1993; Albuquerque et al, 2006; Bergdahl and Bergdahl, 2007; Rivinius, 2009; Dahiya et al, 2013). Previous QST studies have reported mixed results with some reporting BMS patients have higher sensitivity (Grushka et al, 1987; Yang et al, 2019), lower sensitivity (Mo et al, 2015; Hartmann et al, 2017; Kolkka et al, 2019), and no difference in sensitivity (Forssell et al, 2002; Kaplan et al, 2011; de Siqueira et al, 2013; Yilmaz et al, 2016; Watanabe et al, 2019; Honda et al, 2019; Wolowski et al, 2021) of the orofacial region to painful thermal heat stimuli relative to healthy participants (Supplementary Table 1). QST studies outside the orofacial region in BMS patients, such as leg and arm extremities, report no differences in sensitivity to painful thermal heat stimuli compared to healthy participants (de Siqueira et al, 2013; Mo et al, 2015; Hartmann et al, 2017; Honda et al, 2019; Watanabe et al, 2019; Wolowski et al, 2021)

Methods

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Discussion

Conclusion