Burning Mouth Syndrome, otherwise known as BMS, is defined as “an intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without clinically evident causative lesions”. To date, no studies have provided evidence of a reliable and safe treatment for long-term management of BMS both in terms of symptom relief and quality of life. Even clonazepam, which is considered effective for symptom remission in patients with BMS, is associated with potentially serious side effects such as addiction in long term use.
A recent study at the University of Turin in Italy was performed on patients (n=17) with the use of a preparation of a full cannabis plant extract containing 6.3% THC (63 mg/g) and 8% CBD (80 mg/g) from standardized plant material (cannabis flos) by means of Romano-Hazekamp extraction and was diluted in oil (1g of cannabis in 10g of olive oil). The study was performed over a period of 4 weeks.
The subjective sensation of pain and its influence on oral health were assessed with the visual analog scale (VAS), the McGill Pain Questionnaire (MGP), the Present Pain Intensity (PPI) scale, and the Oral Health Impact Profile questionnaires (OHIP-14 and OHIP-49) at the end of the protocol and during the succeeding 24 weeks. Neuropathic pain was also investigated with a specific interview questionnaire, the DN-4 (Douleur Neuropathique en 4 Questions). Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS) and the Geriatric Depression Scale (GDS).
The schedule was prescribed as follows: 5 drops twice daily for 5 days, 10 drops twice daily for 5 days, 15 drops twice daily for 5 days, and 20 drops twice daily for 13 days. Patients were also asked to abstain from using any herbal cannabis or cannabinoids other than the oil provided for the entire study duration. Follow-up visits were conducted at baseline, at the end of the 4-week course of treatment, and then 12 and 24 weeks after the end of treatment.
Subjects showed a statistically significant improvement over time in terms of a clinical remission of the oral symptoms, with improvements shown at 4 weeks and 12 weeks post-treatment, plateauing at 24 weeks. Levels of anxiety and depression changed statistically after treatment was provided, displaying a favorable lessening in severity. Approximately one-third of the patients experienced adverse events, which did not cause any significant treatment modifications. The most frequent adverse event was dizziness, which occurred in 3 (17.6%) patients in the first week of treatment. All reported side effects disappeared within 2 weeks after the end of the therapy.
This study shows the C. sativa oil provided was effective and well tolerated in patients with primary BMS. Further larger-scale properly defined randomized controlled trials, with different therapeutic approaches or placebo control, are needed to determine the effectiveness of cannabis treatment on BMS.
Reference:
Gambino A, Cabras M, Panagiotakos E, et al. Evaluating the Suitability and Potential Efficiency of Cannabis sativa Oil for Patients with Primary Burning Mouth Syndrome: A Prospective, Open-Label, Single-Arm Pilot Study. Pain Med. 2021;22(1):142-151. doi:10.1093/pm/pnaa318
