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Papers of the Week

2020 Sep 18

Scand J Pain

Duloxetine for the management of sensory and taste alterations, following iatrogenic damage of the lingual and chorda tympani nerve.


Objectives Nerve injury may lead to pain and sensory changes such as dysesthesia and paresthesia. Quantitative sensory testing (QST) is a psychophysical testing method used to quantify nerve damage and monitor its recovery. Duloxetine is used in the management of neuropathic pain conditions, but its effect on taste recovery has not been previously reported. Case representation A 65-year-old female, presented to the orofacial pain clinic, with a chief complaint of a burning sensation on the tongue, taste changes and a feeling of tightness beneath the tongue for five months. She reported that the complaints began subsequent to a complicated dental extraction during which she experienced trauma to the tongue. Patient was advised to take duloxetine 60 mg in divided doses three times daily. The assessment and monitoring of the recovery pattern were performed using QST. Electrical taste detection (mediated by chorda tympani) and electrical detection/tingling thresholds were performed at periodic intervals for up to a year following the nerve injury in the chorda tympani and lingual nerve territory. The patient reported complete recovery in taste sensation with duloxetine and this correlated with the QST results. QST documented at the end of one year revealed the electrical taste detection threshold and electrical detection threshold return to near normal values. Conclusions QST may be a useful diagnostic tool to assess and monitor lingual and chorda tympani nerve injuries. Duloxetine may aid in the recovery of the taste changes following lingual and chorda tympani nerve injury.