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

Background: This study investigates how anxiety, depression, and sleep disturbances affect pain perception and clinical impair-ment in burning mouth syndrome (BMS).Methods: 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) as-sessed illness severity, and comorbidities were analyzed via the Age-Adjusted Charlson Comorbidity Index (AACCI). Correlationtests and path analyses explored relationships among psychological factors, sleep quality, and BMS severity.Results: 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 inten-sity (β = 0.24, p < 0.05), indirectly influencing clinical severity (CGI-S: β = 0.07, p < 0.05). Depression strongly impacted poor sleepquality (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.Conclusions: Anxiety amplifies pain intensity, while depression worsens sleep quality, exacerbating clinical outcomes. Shortersleep duration further contributes to worse outcomes. These findings emphasize the need for tailored interventions targetingpsychological distress and sleep disturbances to improve pain management and quality of life in BMS patients