Amitriptyline oral drops for the treatment of burning mouth syndrome: a case series of 13 patients

Burning mouth syndrome (BMS) is a chronic oral neuropathic pain disorder. We conducted a retrospective case series of 13 postmenopausal women with primary BMS treated with low-dose oral amitriptyline administered as liquid drops, allowing flexible titration to the individual minimum effective dose. Pain intensity was assessed using a visual analog scale (VAS), and quality of life was measured with the Dermatology Life Quality Index (DLQI) at baseline and during follow-up (6-12 months). Mean baseline VAS was 7.4 and mean DLQI was 13.8. Clinically meaningful improvement was observed in 92.3% of patients, with complete remission in 6 cases and ≥50% pain reduction in 6 cases. Mean final VAS decreased to 1.7 and mean DLQI to 3.2. Symptomatic relief typically occurred within 2-4 weeks after reaching the effective dose and was maintained during follow-up. Low-dose amitriptyline administered with individualized titration appears to be a safe and effective option for refractory primary BMS.