An article by Ito, et al evaluated the effect of milnacipran for treating chronic pain in the orofacial region, including burning mouth syndrome (BMS) and atypical odontalgia (AO). The study accounted for the influence of concurrent depressive symptoms on the pain-relieving effect. The study initially involved 36 patients (3 men, 29 women, aged 22 to 76 years) with chronic pain in the orofacial region; 22 of the patients had BMS and 10 had AO, and 32 patients completed the study. Milnacipran was administered for 12 weeks, with an initial dose of 15 mg a day, which was increased to 100 mg a day. Pain was assessed using the visual analog scale, and symptoms of depression were evaluated using the Hamilton Depression Rating Scale at baseline and at weeks 1, 2, 4, 6, 8, 10, and 12 of the study treatment. Data from 32 patients who completed the study were included in the analysis. The visual analog scale score significantly decreased after the 12-week treatment, and it showed a similar time course of decline irrespective of concurrent depressive symptoms during the 12 weeks. The study concluded that treatment with milnacipran resulted in a significant improvement of chronic pain in the orofacial region irrespective of concurrent symptoms of depression. These results suggest that milnacipran may be an effective agent for treatment of such disorders
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