Self-Induced Trauma from Compulsive Parafunction

A 32-year-old female presented with a chronic, localized pain from a described burning sensation in the mouth. Primary burning mouth syndrome (BMS) was initially diagnosed and the patient was treated with pharmacological therapies. The neuropathic oral pain was later found to be actualizing from a compulsive parafunctional habit. This case-report aims to emphasize proper diagnosis through additional means of evaluation and utilizing readily available diagnostic tools prior to initiating treatments.

Neuropathic pain is a complex condition initiated by perturbation of the nervous system from lesion, injury or disease [1-3]. It may be related to either or both peripheral and central nervous system disorders [1-4]. Current estimates for neuropathic pain prevalence in the general population range from 6.9-10%, with 7-8% most frequently cited in literature [1,2,5]. Prevalence estimates are expected to increase due to ageing populations, obesity rates, anxiety-related disorders, incidence of diabetes mellitus, and improved survival outcomes of cancer patients post chemotherapy [1,5]. Neuropathic pain may be distinguished as spontaneous or evoked [1,2]. It can be accompanied by paresthesia, dysesthesia, anesthesia or sensations of weakness in associated areas [2,3].

Causes of neuropathic pain can be difficult to identify and manage. Etiology has been linked to trauma, chemotherapy, amputation, nerve compression, post-herpetic neuralgia, stroke, inflammatory disorders, autoimmune disorders and immunocompromising conditions [1,3,4]. Neuropathic orofacial pain can manifest as atypical odontalgia post extraction, trigeminal neuralgia or BMS [3,6,7]. Due to numerous etiologies, multiple attempts to ascertain underlying causes may need to be pursued. It is additionally imperative to assess the severity of the pain while considering individual comorbidities and the overall impact on a person’s work, social and personal life [1].

Keywords: Neuropathic pain; Idiopathic pain; Burning mouth syndrome; Parafunctional habit; Self-induced trauma; Compulsive behavior