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Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e31828c4bf1
Original Articles

Immune and Endocrine Function in Patients With Burning Mouth Syndrome

Koike, Kazuyoshi DDS, PhD*,†; Shinozaki, Takahiro DDS*,†; Hara, Kazuhiko DDS*; Noma, Noboru DDS, PhD*,†; Okada-Ogawa, Akiko DDS, PhD*,†; Asano, Masatake DDS, PhD†,‡; Shinoda, Masamichi DDS, PhD†,§; Eliav, Eli DMD, DDS, PhD; Gracely, Richard H. PhD; Iwata, Koichi DDS, PhD†,§; Imamura, Yoshiki DDS, PhD*,†

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Objectives: Research suggests that varied etiologic factors are responsible for burning mouth syndrome (BMS). We examined the role of immune and endocrine function in the pathology of BMS.

Methods: We conducted a case-control study to evaluate immune (lymphocyte subpopulations) and endocrine (hypothalamus-pituitary-adrenal axis and sympathetic-adrenomedullary system) function in 47 female BMS patients and 47 age-matched female controls presenting at an university clinic. Psychological state was assessed with the Zung Self-Rating Depression Scale and Taylor Manifest Anxiety Scale.

Results: BMS patients were significantly more anxious than controls (P=0.011). Plasma adrenaline level was significantly lower (P=0.020) in BMS patients than in controls, and linear regression analysis of all patients combined revealed that depression level was significantly positively associated with plasma noradrenaline and cortisol levels (P=0.002 and 0.001, respectively). However, as compared with controls, BMS patients had a significantly lower CD8(+) cell count (P<0.001) and a significantly higher CD4/CD8 ratio (P=0.002). Discriminant analysis revealed that CD8(+) cell count and CD4/CD8 ratio were independent variables that distinguished BMS patients from controls.

Discussion: The immunoendocrine system is substantially involved, and may have a key role, in the mechanism of chronic pain in BMS patients. Immune function was significantly and specifically suppressed in BMS, although the hypothalamic-pituitary-adrenal axis and sympathetic nervous system were predominantly activated by psychological stress that was not specific to BMS.

© 2014 by Lippincott Williams & Wilkins

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