477: Burning Mouth Syndrome Treated With Sphenopalatine Ganglion Pulsed Radiofrequency: A Case Report

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation)

Background and Aims: Burning Mouth Syndrome (BMS) is a chronic neuropathic pain condition characterised by persistent oral burning sensation without visible oral or mucosal pathology. Management remains challenging: it frequently responds poorly to pharmacological options, and interventional options are poorly defined. The sphenopalatine ganglion/pterygopalatine ganglion (SPG) is key in craniofacial nociception and autonomic regulation.
This case describes the successful use of a diagnostic SPG block followed by pulsed radiofrequency in a patient with refractory BMS, demonstrating a potential interventional strategy for this condition.

Methods: A 32-year-old female with an 18-month history of severe burning mouth syndrome was assessed in a specialised pain clinic. Pain symptoms involved the tongue, palate, and cheeks with burning neuropathic features. Multiple pharmacological therapies had been attempted with little to no success. A diagnostic US-guided left SPG block (5mls 2% lidocaine + 3.3 mg dexamethasone) was performed, with positive symptom relief. Based on this response, pulsed dose radiofrequency modulation of the left SPG was subsequently undertaken (480 doses + 6.6 mg dexamethasone + 4 mls 1% lidocaine). Pain scores, flare frequency, and functional impact were assessed during each follow-up.

Results: The diagnostic SPG block produced a complete 1-month pain relief in both sides of her mouth, with subsequent progressive recurrence of her symptoms, suggesting a possible autonomically mediated component. After PRF of the left SPG, the patient reported a sustained overall pain reduction of approximately 60–70%, with increased pain-free intervals and reduced flare severity. Although intermittent flares persisted as the effect lessened over time, symptoms remained significantly improved compared to baseline. The patient tolerated the procedure well with no reported complications.

Conclusions: This case suggests that diagnostic sphenopalatine ganglion block followed by pulsed radiofrequency may provide meaningful benefit in symptom relief in selected patients with refractory burning mouth syndrome. SPG-targeted interventions may be considered as valuable diagnostic and therapeutic options in complex orofacial neuropathic pain. Larger studies are required to define patient selection and duration of benefit.

References: 1. Klasser GD, Epstein JB, Villines D. Diagnostic challenges of burning mouth syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(4):463–476.
2. Jääskeläinen SK. Pathophysiology of primary burning mouth syndrome. Clin Neurophysiol. 2012;123(1):71–77.
3. Piagkou M et al. The pterygopalatine ganglion and its role in pain management. Pain Pract. 2012;12(5):399–412.
4. Chua NH et al. Pulsed radiofrequency treatment in chronic pain. Anaesth Intensive Care. 2011;39(4):608–612.

Presenting Author: James Jack
Submitting Author: Pablo Rojas

Senior Author: James Jack

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• James Jack: MBBS FRCA FFPMRCA - Epsom and St Helier Hospital
• Samina Shah: MBBS FRCA FFPMRCA - Epsom and St Helier Hospital
• Sara Bustamante Sainz: LMS FRCA FFPMRCA - Epsom and St Helier Hospital