# Inside the Fire. Exploring the Impact of Anxiety, Depression, and Sleep Disturbances on Pain Perception in Burning Mouth Syndrome: A Cross‐Sectional Study of 200 Patients

## TL;DR

This study shows that anxiety and poor sleep worsen pain and clinical outcomes in burning mouth syndrome patients, highlighting the need for targeted psychological and sleep interventions.

## Contribution

The novel contribution is identifying specific psychological and sleep factors that directly and indirectly influence pain intensity and clinical severity in BMS.

## Key findings

- Anxiety increases pain intensity and indirectly affects clinical severity in BMS patients.
- Depression significantly impacts sleep quality, worsening clinical outcomes.
- Shorter sleep duration is linked to poorer sleep quality and worse clinical outcomes.

## Abstract

This study investigates how anxiety, depression, and sleep disturbances affect pain perception and clinical impairment in burning mouth syndrome (BMS).

A cross‐sectional survey was conducted on 200 BMS patients. The Hamilton Rating Scale for Depression (HAM‐D) and Anxiety (HAM‐A), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Visual Analogue Scale (VAS), and short form of McGill pain questionnaire (SF‐MPQ) were used. The Clinical Global Impressions Severity of Illness (CGI‐S) assessed illness severity, and comorbidities were analyzed via the Age‐Adjusted Charlson Comorbidity Index (AACCI). Correlation tests and path analyses explored relationships among psychological factors, sleep quality, and BMS severity.

Pain intensity (VAS) correlated significantly with anxiety (HAM‐A, ρ = 0.25, p < 0.05), depression (HAM‐D, ρ = 0.15, p < 0.05), and shorter sleep duration (ρ = −0.19, p < 0.05). Path analyses revealed that anxiety significantly increased pain intensity (β = 0.24, p < 0.05), indirectly influencing clinical severity (CGI‐S: β = 0.07, p < 0.05). Depression strongly impacted poor sleep quality (PSQI, β = 0.33, p < 0.05). Shorter sleep duration affected both sleep quality (β = −0.46, p < 0.05) and clinical outcomes (CGI‐S, β = −0.17, p < 0.05). Pain quality (SF‐MPQ) showed weaker, non‐significant associations with psychological factors.

Anxiety amplifies pain intensity, while depression worsens sleep quality, exacerbating clinical outcomes. Shorter sleep duration further contributes to worse outcomes. These findings emphasize the need for tailored interventions targeting psychological distress and sleep disturbances to improve pain management and quality of life in BMS patients.