The effectiveness of acupuncture versus clonazepam in patients with burning mouth syndrome A Jurisic Kvesic, 1 I Zavoreo, 2 V Basic Kes, 2 V Vucicevic Boras, 3 D Ciliga, 4 D Gabric, 5 D V Vrdoljak 6 1 Private Dental Practice, Zagreb, Croatia 2 Clinic for Neurology, Clinical Hospital Centre Sisters of Mercy, Zagreb, Croatia 3 Department of Oral Medicine, School of Dental Medicine and Clinical Hospital Centre, Zagreb, Croatia 4 Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia 5 Department of Oral Surgery, School of Dental Medicine, University of Zagreb, Zagreb, Croatia 6 Clinic for Tumours, Clinical Hospital Centre Sisters of Mercy, Zagreb, Croatia Correspondence to Dr V Vucicevic Boras, School of Dentistry, University of Zagreb, Gunduliceva 5, and Clinical Hospital Centre Zagreb, Kispaticeva 12, Zagreb 10 000, Croatia; boras@sfzg.hr Accepted 29 April 2015 To cite: Jurisic Kvesic A, Zavoreo I, Basic Kes V, et al. Acupunct Med Published Online First: [ please include Day Month Year] doi:10.1136/acupmed-2015- 010759 ABSTRACT Objective Burning mouth syndrome (BMS) is a chronic oral condition, characterised by burning symptoms, which mainly affects perimenopausal and postmenopausal women. Neuropathy might be the underlying cause of the condition. There are still insufficient data regarding successful therapy. The aim of this study was to compare the effectiveness of acupuncture and clonazepam. Methods Forty-two patients with BMS (38 women, 4 men) aged 66.7±12.0 years were randomly divided into two groups. Acupuncture was performed on 20 participants over 4 weeks, 3 times per week, on points ST8, GB2, TE21, SI19, SI18 and LI4 bilaterally as well as GV20 in the midline, each session lasting half an hour. Twenty-two patients took clonazepam once a day (0.5 mg in the morning) for 2 weeks and, after 2 weeks, two tablets (0.5 mg in the morning and in the evening) were taken for the next 2 weeks. Prior to and 1 month after either therapy, participants completed questionnaires: visual analogue scale, Beck Depression Inventory, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale, 36-item Short Form Health Survey (SF-36) and Montreal Cognitive Assessment (MoCA). Results There were significant improvements in the scores of all outcome measures after treatment with both acupuncture and clonazepam, except for MoCA. There were no significant differences between the two therapeutic regimens regarding the scores of the performed tests. Conclusions Acupuncture and clonazepam are similarly effective for patients with BMS. INTRODUCTION Burning mouth syndrome (BMS) is a chronic condition characterised by burning symptoms in the oral cavity, which usually affects perimenopausal and postmenopausal women. It seems that underlying neuropathy (either peripheral, central or both) might be the cause of the condition. Treatment of patients with BMS is mostly based on medication, although cognitive behavioural therapy certainly helps patients to cope better with the condition. 1 Drugs whose effect- iveness in the management of BMS has been established in clinical trials are: α-lipoic acid, topical and systemic clona- zepam, systemic capsaicin, trazodone, amisulpride, paroxetine and sertraline. 23 However, some of these medications have side effects, such as drowsiness from clonazepam, gastric pain from systemic capsaicin, and drowsiness and dizziness from trazodone. 2 Topical clonazepam may be absorbed systemically and lead to benzodiazepine dependence if used for a prolonged period. 3 Acupuncture is well known to be helpful in many other painful conditions such as low back pain, headaches and migraine, osteoarthritis and diabetic peripheral neuropathy. 4 Although the literature published to date in Chinese supports the use of acupuncture in BMS, there are few published studies in the Western literature on the effect of acu- puncture in patients with BMS. 5–8 The aim of this study was to compare traditional Chinese acupuncture and clo- nazepam in the treatment of BMS. MATERIALS AND METHODS A randomised controlled trial was con- ducted comparing 4 weeks of treatment with acupuncture or clonazepam. Patients were randomised by the simple randomisation method of flipping a coin (heads: acupuncture; tails: clonazepam). Original paper Jurisic Kvesic A, et al. Acupunct Med 2015;0:1–4. doi:10.1136/acupmed-2015-010759 1 Copyright 2015 by British Medical Journal Publishing Group. group.bmj.com on May 18, 2015 - Published by http://aim.bmj.com/ Downloaded from