[논문]구강작열감증후군의 치료를 위한 전신적 클로나제팜의 투여 시 환자의 임상적 특징에 따른 효능의 차이에 관한 연구

민보경; 정재광; 최재갑

doi:10.14476/jomp.2012.37.3.161

구강작열감증후군의 치료를 위한 전신적 클로나제팜의 투여 시 환자의 임상적 특징에 따른 효능의 차이에 관한 연구
Clinical Features Affecting the Efficacy of Systemic Clonazepam for Management of Burning Mouth Syndrome 원문보기

대한구강내과학회지 = Korean journal of oral medicine, v.37 no.3, 2012년, pp.161 - 167

민보경 (경북대학교 치의학전문대학원 구강내과학 교실) , 정재광 (경북대학교 치의학전문대학원 구강내과학 교실) , 최재갑 (경북대학교 치의학전문대학원 구강내과학 교실)

초록
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구강작열감증후군은 구강점막의 만성통증성 작열감이다. 구강작열감증후군의 치료로는 약물치료, 심리치료가 있다. 과거의 연구를 통해 캡사이신, 알파-리포산, 도포용 클로나제팜, 전신적 클로나제팜이 구강작열감증후군 증상의 감소에 효과적임이 보고되었다. 이 연구의 목적은 구강작열감증후군 환자에게 전신적 클로나제팜을 투여하여 치료 효과를 평가하고 약제의 효능과 연령, 통증의 강도, 통증의 기간, 과거의 치과병력, 구강점막 상태 등의 다양한 임상적 특징과의 관계를 밝히는 것이다. 이 연구는 2011년 1월과 2012년 8월 사이에 구강작열감증후군으로 진단된 환자를 대상으로 후향적 임상자료 분석을 통해 이루어졌다. 환자들에게 0.5mg 클로나제팜을 하루 2회 처방하였다. 통증은 전신적 클로나제팜의 투여 전과 투여 1-2주 후에 11-점 숫자등급척도(11-point numeric rating scale, NRS)를 통해 측정되었다. 클로나제팜의 효능은 환자의 연령, 초기 통증 강도, 통증 지속기간, 유발인자의 존재유무, 혀의 상태, 의치착용 유무에 따라 평가되었다. 총 50명의 환자(여성 46명, 남성 4명)가 연구에 참여하였다. 환자들은 상기의 임상적 특징에 따라 2-3개의 군으로 나누었다. 강한 초기 통증 환자들의 평균 NRS 감소량은 $3.33{\pm}2.74$인 반면에 경도 혹은 중등도 초기 통증 환자들의 평균 NRS 감소량은 $1.64{\pm}1.54$였다. 70세 이상의 가장 높은 연령의 환자군의 평균 NRS 감소량은 $3.53{\pm}1.94$였으며, 60세 이하 환자군에서는 $2.88{\pm}1.80$, 60세에서 70세 사이 환자군에서는 $1.54{\pm}2.86$의 감소량을 보였다. 결론적으로 높은 연령의 환자들과 강한 초기 통증을 가진 환자들에게서 클로나제팜의 효능이 뛰어난 경향이 있다. 그러나 통증 기간, 유발인자 유무, 열구설 유무, 의치 장착 유무에 의한 클로나제팜의 효능의 차이는 통계학적 유의성이 없었다.

Abstract ▼ AI-Helper

Burning mouth syndrome(BMS) is defined as chronic, painful burning sensation in the oral mucosa. Treatments for BMS include medication and psychiatric interventions. Capsaicin, alpha-lipoic acid, and topical and systemic clonazepam showed more effective in reducing the symptoms of BMS in the previous studies. The purpose of this study is to evaluate of the therapeutic efficacy of systemic clonazepam in BMS and to elucidate the relationships between such a efficacy and various clinical features, including age, pain intensity, pain duration, previous dental history and condition of oral mucosa. A retrospective clinical records audit was performed of patients diagnosed with BMS between January 2011 and August 2012. Patients were prescribed 0.5 mg clonazepam two times daily. Pain was assessed by patients on an 11-point numeric rating scale (NRS; 0 to 10) before and 1-2 weeks after systemic administration of clonazepam. The efficacy of clonazepam was evaluated in terms of patient's age, initial pain intensity, pain duration, presence or absence of precipitating event, condition of the tongue, presence or absence of denture. A total of 50 patients (46 women, 4 men) were included in this study. The patients were divided into two or three groups according to above clinical features. The amount of mean NRS reduction in patients with severe initial pain was $3.33{\pm}2.74$, whereas that in patients with mild initial pain was $1.64{\pm}1.54$. The amount of mean NRS reduction in oldest patients was $3.53{\pm}1.94$ (${\geq}$70yrs), and those in another younger patients were $2.88{\pm}1.80$(< 60yrs) and $1.54{\pm}2.86$(60yrs ${\leq}$ age < 70yrs), respectively. It was concluded that the older patients and the patients with higher intensity of initial pain tend to show better efficacy of clonazepam. However, There were no statistically significant differences according to pain duration, presence or absence of precipitating events, tongue fissuring, and wearing dentures.

주제어

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제안 방법

Regarding relationship between the pain duration and the therapeutic effect, the patients were divided into two groups by chronicity: group 1 (pain duration ≤ 6 months, n=26) and group 2 (6months < pain duration, n=24).
The purpose of this study is to evaluate of therapeutic efficacy of systemic clonazepam in BMS and to elucidate the relationships between the efficacy and age, pain intensity, pain duration, previous dental practice and condition of oral mucosa.
To define the clinical characteristics of patients affecting the efficacy of systemic clonazepam, patients were divided into two or three subgroups by age, pain duration, initial pain intensity, precipitating events, clinical features of tongue and denture condition or quality.
To estimate the response to clonazepam according to the condition of oral mucosa, the difference of the mean NRS reduction between fissured tongue group and normal tongue group was examined. The mean NRS reduction in fissured tongue group was 3.
To evaluate the influence of oral dentures on the outcome clonazepam therapy, a comparison of the mean NRS reduction between the patients wearing dentures and those not wearing dentures was made. The mean NRS reduction in patients with denture was 3.
To identify the effect of initial pain intensity to the therapeutic outcome, the patients were divided into two groups according to the initial NRS. The mean initial NRS of all patients was 6.
To investigate the relationship between NRS reduction and previous dental treatment as precipitating factor, the amount of NRS reduction in group with previous dental history as precipitating factor was compared to that in group without the onset-related events. The patients with previous dental history as precipitating factor showed less reduction in the mean NRS when compared to the patients without onset-related events.

대상 데이터

A retrospective clinical records audit was performed of patients diagnosed with BMS between January 2011 and August 2012. A group of 50 patients (4 males; ages 53-73years, 46 females; ages 38-89years) with a complaint of burning pain in the oral area without any causative signs included in the study.
Of the 50 patients enrolled in the study, 46 were female (mean age 63.46±10.88) and 4 were male (mean age 63.50±8.23).
This study was carried out at the Department of Oral medicine in Kyungpook National University Hospital. A retrospective clinical records audit was performed of patients diagnosed with BMS between January 2011 and August 2012.

데이터처리

Changes in pain intensity between first and second visit were compared among each subgroups using one way ANOVA test, Mann-Whitney U-test and two sample t-test (SPSS 18.0.0., 2009). All of data are expressed as mean±SD, and the significance level was set to P < 0.
To evaluate the influence of age on efficacy of systemic clonazepam therapy, the patients were divided into three groups by the following age criteria: group 1 (age < 60, n=17), group 2 (60 ≤ age < 70, n=19) and group 3 (age ≥ 70, n=14). The amount of NRS reduction was compared among the groups using one way ANOVA test. The mean NRS reduction were 2.

이론/모형

In first visit, patient history was taken by interview and questionnaire. Burning pain intensity of individuals was measured using an 11-point numeric rating scale (NRS). Patients were asked to choose a number between 0 and 10.

성능/효과

In conclusion, it was shown the more NRS reduction in both oldest patients and patients with high initial pain intensity after administration of systemic clonazepam. On the other hand, there were no significant difference of mean NRS reduction according to pain duration, precipitating factors, fissured tongue and wearing dentures.
94 in group 3. In spite of the lowest reduction in group 2, the mean NRS reduction between group 1 and group 2 showed no significant difference, whereas the mean NRS reduction in group 3 with oldest age was significantly higher. The mean initial NRS were 5.
These results indicated that the clinical outcomes following the systemic application of clonazepam to BMS seemed to be influenced by initial pain intensity and age. These findings suggested that the initial pain intensity and age could be one of important factors in the prognosis for patients with BMS during the systemic application of clonazepam.

후속연구

This fact may explain the present result of greatest reduction of NRS in oldest patients by the systemic application of clonazepam. But further investigations are needed to clarify the effect of age on the outcome of systemic medication for BMS.
Moreover, in some patients with orofacial dystonia, dentures can make multiple sore spots as well as BMS symptoms. In the study, it did not found the difference between patients with and without denture, but more extensive studies should be established.

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