Misconceptions about Burning Mouth Syndrome: Myths, Anxiety, and Chronic Pain

Some of the scientific articles actually say Burning Mouth Syndrome is a cancer phobia. Other misconceptions are that stress causes burning mouth. Another theory is that it’s a somatization disorder, meaning instead of feeling your feelings such as sadness, you develop mouth pain.

Misconceptions about Burning Mouth Syndrome

Let’s talk about misconceptions about Burning Mouth Syndrome. Because for me, this has been one of the most, concerning, features in people suffering from Burning Mouth Syndrome. This is that it’s in your head, that you’re anxious, and/or you’re depressed. Some of the scientific articles actually said it was cancer phobia. Fear of cancer that made people have burning in their mouth, Other journals say that it is stress. Or that it’s a somatization disorder, meaning instead of feeling your feelings, if you’re really sad, you’ll get a stomachache. And there are some people that have trouble expressing their feelings and they will get aches and pains as their way of saying that they’re emotionally not feeling good. But this certainly is not a somatization disorder. This has a physical basis.

Anxiety, depression, and stress play a role

There are a lots of misconceptions about Burning Mouth Syndrome and anxiety, depression, and stress. Does anxiety, depression, and stress play a role?  For sure, but I’m going to tell you how there’s definite physiologic reasons for how these things are tied together. First, any chronic pain syndrome causes depression. We know that. If you compare people with Burning Mouth Syndrome to age matched controls, more than 50% of the burning mouth, people will have depression and anxiety. But if you look at other chronic pain syndromes, you’ll find that the rates of depression and anxiety are similar because living with chronic pain is really difficult.

And then there was an article that I honestly, I couldn’t believe it when I read it. This article said that, it basically is referring to women because of course that’s mainly who has burning mouth syndrome. People watching upsetting soap operas on TV is the reason why they are having Burning Mouth Syndrome. And that actually was in a scientific article, believe it or not.

It’s got to be in your head

The problem with healthcare professionals is they assume just because we can’t see anything and there’s no testing for it, but it’s got to be in your head. That is wrong. So, we’re going to talk about really what is Burning Mouth Syndrome and what do we know about it currently. Before I do that, I want to talk to you about different types of pain: acute pain, and chronic pain.

Acute and chronic pain

Acute pain, serves a number of functions, right? If you put your hand near a flame, you feel pain and it’s a signal to your body to withdraw your hand from that danger. So, it helps us get out of danger. The other thing that it can do, if you twist your ankle, it hurts right when you twist it, and it keeps hurting for a while. What that does is tell us to take care of it, not put weight on it, and not go about our everyday activities as if it didn’t happen. That is because it needs to be immobilized for a while so that it can heal. So acute pain serves as protective and healing functions, and it keeps us alive. People that are born without pain sensations generally die much earlier than average age, because they do not feel the pain that warns them, that dangerous

Chronic pain ends up being something where it’s not related to what’s just happened. If you have an acute pain, if you get a tiny cut on your finger, it hurts a little. If you get a great big gash, it hurts a lot. And what happens with chronic pain is that you lose the relationship between the amount of damage to the tissue and the amount of pain. And so, you end up with the situation where a very small initial insult can end up magnifying into a very large pain. It can be more intense than what the original insult would call for. It can be over a larger area of the initial insult. It could have been the tip of your finger. Now your whole arm hurts. Eventually it takes on a life of its own. So even though the initial insult is over, the pain keeps going, and these are the characteristics of chronic pain, which is what burning mouth syndrome is.

Pain is a two-way street

Pain is a two-way street. So, we’re aware of pain as a sign of danger, right? You put your hand or a burning flame. You withdraw it because it feels hot and you keep yourself from getting hurt. That’s not the only thing that happens. The message from the tip of your finger, that there is something super-hot there that goes to your brain. And then your brain pulls your hand back. It’s a two-way street.

There are pain inhibiting messages that go from your brain to the tip of your finger. That’s going on all the time. When we sense pain, pain goes up and pain, dampening signals come down. When there’s a mismatch and you don’t get enough. Dampening signals, all you get are pain sensation going up to your brain all the time, telling your brain that there’s a bad pain going on.

And the other way that pain is a two-way street is in your nerves. There are always two processes going on. One is inflammation. It is part of telling your body to get out of danger and to rest and heal. So, inflammation is a normal, healthy, and protective, as long as it doesn’t run away with itself and become chronic. Some of the factors in chronic pain are that there are chemicals that are inflammatory factors. These chemicals are  in our nerves. Things like histamine and something called Calcitonin Gene-Related Peptide (CGRP). These are inflammatory irritants to nerves.

There are healing chemicals

On the other hand, we have a number of healing, chemicals.  Brain Derived Neurotrophic Factor (BDNF), is very healing and calming to nerves.  In addition, the innate repair receptor and nerves is very calming to nerves. So, we have these two things going on all the time. They are a part of the balance of keeping us healthy so that we can get out of danger. But when it becomes a chronic problem, and when things aren’t going properly, you will have too much of the inflammation. This causes pain and not enough of the healing factors.

So, our therapy needs to be geared at calming the inflammation and increasing the healing factors. How do we do that? I’ll tell you in a little while. I’ve just finished talking about what Burning Mouth Syndrome is. Again, It is a chronic pain and it’s a neuropathic pain or neuropathy. Neuropathy means a disease or a disorder of nerves, which typically causes numbness, weakness, or pain. For burning mouth it is pain and burning,

What is neuropathic pain? So, if you have a pinched nerve in your neck, and it’s on the right side, you’ll feel pain down your right arm. With neuropathic pain. It can suddenly be on the other side of your body or be lower down or be higher up. It starts to take on a life of its own. It’s not limited to what we see with an acute insult and acute injury. This is one really interesting lesson in Burning Mouth Syndrome.

Let’s talk about dopamine

Let’s talk about dopamine. It is a neurochemical. In addition, It’s a neurotransmitter. It is found in our brains and it’s our reward hormone. So, you’ve heard of dopamine and it’s loke social media or texting on your phone. You know, you get excited and you look forward to getting a new text. And that releases dopamine. Dopamine is also what gives people initiative and drive to get things done, to achieve a goal.

Dopamine also lessens pain. When they did specific dopamine brain scans in people with Burning Mouth Syndrome, their scans look like people with Parkinson’s disease. What do we know about Parkinson’s? Parkinson’s is a low dopamine disease. The areas in the brain that are sensitive to dopamine become injured and, resistant to dopamine and don’t function well anymore. And people end up with a tremor or difficulty walking. So those are different neurological consequences.

The fact is it’s been proven that dopamine levels are low in the brain of people with Burning Mouth Syndrome. So, you have lost some of your pain, dampening chemicals when your dopamine levels go down. Also, low dopamine also can cause depression and anxiety. So, this is the one of the physiologic connections between having pain and the depression and anxiety. So, you not only are depressed and anxious because you are having pain and you can’t do the things you want to do in life. Therefore, your life is severely impacted. You actually have a physiologic reason, which is low dopamine that is occurring with burning mouth. Also low dopamine causes anxiety and  depression.