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LETTER TO THE EDITOR

Gabapentin for the Treatment of Glossodynia due to an Unusual Cause

Department of Anesthesiology and CCM; Indira Gandhi Institute of Medical Sciences; Patna, India; pkdubey{at}hotmail.com

To the Editor:

Chewing of "paan" is a common addiction across the Indian subcontinent. A betel leaf is smeared with lime paste and catechu paste (an astringent resinous substance obtained from a tropical plant) on one side. After putting small pieces of betel nut and tobacco on it, the leaf is wrapped around them and the entire contents put in the mouth to be slowly chewed. If the lime paste is not properly mixed with catechu paste, it causes chemical injury to the oral mucosa. The hard pieces of betel nut may mechanically aggravate this injury.

Gabapentin has been used for the treatment of postoperative dysesthetic pain.1 We describe a patient with refractory posttraumatic glossodynia successfully treated with gabapentin. The suspected neuropathic pain was due to trauma to the tongue resulting from chewing paan.

A 36-yr-old patient reported to our pain clinic complaining of pain along the right lateral border of his tongue for the past month. Two months earlier he noted a peanut size swelling on the under surface of the right lateral border of the tongue after chewing paan. Oral antibiotics, anti-inflammatory agents, and antiseptic mouthwashes were prescribed. The swelling subsided after 3 days and he remained asymptomatic for 1 mo following which he started having mild burning pain at the site of the previous swelling. The pain was spreading along the lateral border of the tongue towards his throat and increasing in intensity. Diclofenac, Tramadol, and tricyclic antidepressants were prescribed without benefit.

The visual analog pain score was 8/10 and gabapentin at a starting dose of 300 mg once per day increasing to three times per day was prescribed. The visual analog pain score decreased to 2/10 after 10 days. The patient became pain free on the same dosage after 15 days and the gabapentin was gradually eliminated over the following 3 mo.

Because we suspected that the pain was of neuropathic origin and the chemical and/or mechanical injury caused by paan chewing may have been the triggering factor, we elected to use gabapentin in this case2 despite it being a costly agent because of its favorable safety profile and lack of drug interactions.

REFERENCES

1. Otley CC. Gabapentin for the treatment of dysesthetic pain after reconstructive surgery. Dermatol Surg 1999;25:487–8[Web of Science][Medline]
2. Laird MA, Gidal B. Use of gabapentin in the treatment of neuropathic pain. Ann Pharmacother 2000;34:802–7[Abstract]

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