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THERAPEUTIC INNOVATIONS IN THE MANAGEMENT OF
GLOSSALGIA DURING THE CLIMACTERIC PERIOD: A FOCUS ON
QUALITY OF LIFE AND NEUROGENIC FACTORS
Masharipov Sirojbek Madiyorovich
Kuryazov Akbar Kuranbayevich
Urgench Branch of the Tashkent Medical Academy
https://doi.org/10.5281/zenodo.15684107
Glossalgia, often referred to as burning mouth syndrome (BMS), remains a
challenging condition in menopausal women due to its multifactorial origin and
chronic course. As traditional symptomatic approaches often fail to deliver
lasting relief, recent attention has shifted to innovative therapeutic modalities
that target neurogenic pathways and psychosomatic mechanisms. This review
discusses current advances in the management of glossalgia in the climacteric
period, emphasizing multimodal therapies aimed at improving both symptom
severity and patients' quality of life. Emerging evidence supports the integration
of neurotrophic agents, cognitive-behavioral therapy, and non-hormonal
pharmacological options tailored to individual profiles.
Glossalgia is a chronic pain condition characterized by persistent burning
or tingling sensations in the oral mucosa, often without observable lesions. It is
most prevalent in perimenopausal and postmenopausal women, affecting their
emotional well-being, nutritional status, sleep quality, and overall quality of life
(Yilmaz et al., 2017).
Despite its high prevalence, the pathophysiology of glossalgia remains
poorly understood. Neurogenic and psychogenic mechanisms, often intertwined
with the hormonal fluctuations of menopause, are now recognized as critical
contributors. Conventional treatments, such as vitamin supplementation or
topical anesthetics, frequently prove insufficient, highlighting the need for a
more targeted and comprehensive approach.
Etiopathogenesis: A Neurogenic and Psychosomatic Perspective
Recent research suggests that glossalgia is primarily a neuropathic pain
syndrome involving both peripheral and central nervous system dysfunction
(Svensson & Baad-Hansen, 2005). Peripheral nerve injury or dysfunction may
result in spontaneous pain signals, while central sensitization mechanisms
amplify pain perception.
Furthermore, psychosomatic contributors—including depression, anxiety,
and sleep disturbances—can exacerbate symptoms and complicate treatment. A
meta-analysis by Woda et al. (2009) indicated that over 60% of glossalgia
patients exhibit comorbid psychiatric symptoms.
SOLUTION OF SOCIAL PROBLEMS IN
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The decline in estrogen levels during the climacteric phase may indirectly
affect neurotransmitter function, particularly serotonergic and dopaminergic
systems, both of which modulate pain and mood regulation. This hormonal-
neurogenic interplay underscores the importance of multimodal interventions.
Impact on Quality of Life
Glossalgia is more than a localized oral issue—it significantly disrupts
quality of life. Studies using the Oral Health Impact Profile (OHIP-14) and the
Short-Form Health Survey (SF-36) have documented substantial declines in
social functioning, role-emotional, and vitality domains among affected women
(Bergdahl & Bergdahl, 2001).
Moreover, persistent oral discomfort affects dietary habits, often leading to
nutritional deficiencies, weight loss, and gastrointestinal issues. The condition
may also impair verbal communication and intimacy, creating emotional
withdrawal and social isolation.
The recognition of these psychosocial dimensions is vital in constructing
individualized care strategies that aim not only to reduce pain but also to restore
a meaningful daily life.
Therapeutic Innovations and Evidence-Based Approaches
1. Neurotrophic and Anticonvulsant Agents
Recent randomized controlled trials have highlighted the role of
neurotrophic medications in restoring peripheral nerve function. Clonazepam,
administered as a topical mouth rinse or low-dose oral agent, provides
significant symptom relief by modulating GABAergic transmission (Jaaskelainen
et al., 2012).
Gabapentin and pregabalin, used off-label, target voltage-gated calcium
channels and reduce nerve excitability. Several clinical series report reductions
in burning sensations, improved sleep quality, and fewer relapses over 6–12
months.
2. Non-Hormonal Systemic Therapies
While hormone replacement therapy (HRT) can be effective, it is
contraindicated in many patients. Alternatives such as alpha-lipoic acid (ALA),
zinc supplements, and capsaicin-based products have gained attention.
ALA, a potent antioxidant, has shown promise in reversing oxidative nerve
damage. Femiano et al. (2003) demonstrated that daily ALA supplementation led
to statistically significant symptom reductions after 2 months of treatment.
Topical capsaicin may help desensitize oral nociceptors through repeated
TRPV1 receptor stimulation, although its initial use can be irritating.
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3. Cognitive-Behavioral Therapy (CBT) and Psychological Support
Given the high incidence of comorbid anxiety and depression in glossalgia
patients, CBT has emerged as a valuable adjunct. Techniques that include
relaxation training, cognitive reframing, and guided imagery help patients
recontextualize pain and manage emotional stress (Reichart & Philip, 2010).
In an interventional study involving 70 postmenopausal women, those who
received weekly CBT sessions for 6 weeks showed significant reductions in both
pain intensity and depression scores compared to controls receiving standard
oral care.
4. Transcranial Magnetic Stimulation (TMS)
As an emerging non-invasive technique, TMS modulates neural activity in
pain-processing brain regions. Although still experimental in BMS treatment,
initial pilot studies report short-term relief in refractory patients (Cruccu et al.,
2016). Further clinical trials are underway to determine its safety and efficacy
for broader clinical use.
5. Multidisciplinary Treatment Programs
Current best practice suggests that a combination of interventions, tailored
to each patient’s neuroendocrine status, psychological profile, and symptom
history, yields the most sustainable outcomes. This includes coordinated care
between dentists, neurologists, gynecologists, and mental health professionals.
Patients receiving multidisciplinary care have reported faster symptom
resolution, improved coping ability, and decreased reliance on long-term
medications.
Clinical Practice Recommendations
Initial Evaluation should include comprehensive history, oral examination,
depression/anxiety screening, and salivary hormone panel.
Stepwise Therapy: Begin with topical or systemic clonazepam/ALA. Add
gabapentin or SSRI if needed.
Psychological Referral: Strongly recommended for patients with
significant emotional distress.
Non-Pharmacologic Support: Nutritional counseling, oral moisturizers,
stress management workshops.
Long-Term Monitoring: Regular follow-up for relapse prevention and
therapy adjustment.
As the understanding of glossalgia deepens, research is shifting toward:
Identification of salivary biomarkers for early detection.
SOLUTION OF SOCIAL PROBLEMS IN
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Investigation of genetic polymorphisms affecting estrogen receptors and
pain sensitivity.
Integration of telemedicine platforms for long-term support and remote
CBT delivery.
Development of novel agents targeting the trigeminal nociceptive system.
Conclusion
Glossalgia in climacteric women is a multidimensional disorder rooted in
neurogenic and psychosomatic alterations. Standard treatments alone are rarely
sufficient. Innovative therapies—ranging from neuroprotective drugs and
cognitive-behavioral interventions to emerging neuromodulatory techniques—
represent a new frontier in patient-centered care. Improving quality of life
requires not only relieving pain but also addressing the broader emotional and
functional limitations associated with this complex syndrome.
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