Burning Mouth Syndrome: Understanding the Biopsychosocial Dimensions of Invisible Pain

OBJECTIVE: To analyse the biopsychosocial impact of burning mouth syndrome (BMS) on quality of life related to oral health, and to study the influence of perceived invalidation, stigma, and catastrophising on the experience of pain. MATERIALS AND METHODS: Observational study of cases and controls with a sample of 226 participants (BMS group n = 156 and Control group n = 70), recruited at the University Dental Clinic of the Morales Meseguer Hospital. The following tests were administered: BPI-SF (pain and functioning interference), SSCI-8 (global stigma), ISC (internalised stigma), 3*I (perceived invalidation), HADS (anxiety and depression), PCS-6 (catastrophising scale), OHIP-14 (quality of life related to oral health) and the diagnostic legitimacy perception scale. RESULTS: The BMS patients presented significantly worse scores in all the variables analysed with respect to the healthy controls (p < 0.001), especially in oral health quality of life and catastrophising. In the regression models, the perceived invalidation showed an independent and consistent association with a worse oral health quality of life (p < 0.001), higher intensity of pain (p < 0.001) and higher perceived stigma (p < 0.001). CONCLUSIONS: BMS had a strong impact on the quality of life and emotional well-being of the patients. The perceived invalidation emerged as a factor that is closely related to pain, stigma, and deterioration of quality of life, which supports the need for a comprehensive approach that includes not only clinical management but also the recognition and validation of the experience of the patient. These findings reinforce the need for a multidisciplinary approach that includes clinical, psychological, and social dimensions in the management of BMS.