QTc Shortening on Electrocardiogram With Amitriptyline May Indicate No Effect on Pain Relief in Burning Mouth Syndrome

Objective: Burning mouth syndrome (BMS) is an intractable chronic pain disorder characterized by a burning sensation without organic abnormalities in the oral mucosa. Amitriptyline may be effective for BMS or, conversely, may exacerbate pain. QTc is necessary for monitoring psychotropic side effects, but it is not known if it is a predictor of efficacy for BMS. We investigated the efficacy of amitriptyline in BMS and its effect on QTc.
Methods: Visual Analogue Scale (VAS) and electrocardiogram (ECG) were examined before and one month after treatment in 51 consecutive patients diagnosed with BMS according to the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria and treated with amitriptyline.
Results: There were 26 amitriptyline responders and 25 non-responders, with no differences in age, gender, and amitriptyline dosage. Amitriptyline responders showed little change in QTc, while non-responders showed a trend toward significantly shorter QTc. Changes in VAS correlated statistically significantly with changes in QTc (Spearman's rank correlation coefficient: 0384; p=0.0054). The degree of pain tended to worsen with QTc shortening.
Conclusion: Amitriptyline provides analgesia in about half of BMS patients, but some BMS patients have worse pain with amitriptyline. Changes in the QTc not only detect amitriptyline side effects with prolongation, but conversely its shortening predicts amitriptyline ineffectiveness.

論文本文は2025-01-29以降公開予定

This is a pre-copyedited, author-produced version of an article accepted for publication in ​Clinical Neuropharmacology. The published version of record Nagamine, Takahiko MD, PhD; Watanabe, Takeshi DDS, PhD; Toyofuku, Akira DDS, PhD. QTc Shortening on Electrocardiogram With Amitriptyline May Indicate No Effect on Pain Relief in Burning Mouth Syndrome. Clinical Neuropharmacology (): 10.1097/WNF.0000000000000583, January 29, 2024. is available online at: https://doi.org/10.1097/WNF.0000000000000583.