Beyond Oral Pain: A Unique Case of Burning Mouth Syndrome With Coexisting Vulvodynia and Cognitive Impairment in a Postmenopausal Woman.

Burning mouth syndrome (BMS) is a chronic pain condition characterized by persistent intraoral burning without an identifiable cause, predominantly affecting postmenopausal women. We present a unique case of a 63-year-old Ethiopian woman exhibiting a distinctive triad of BMS, vulvodynia, and progressive cognitive decline, an association not previously documented in the literature. Symptoms progressed sequentially-oral pain first, followed by vulvar burning, and later cognitive decline-remaining resistant to multiple pharmacologic treatments. Diagnostic evaluation revealed significant cognitive impairment, particularly affecting language and executive functioning. Trials of pregabalin and vortioxetine yielded transient but modest symptom relief. Notably, the patient's cognitive deterioration appeared to fluctuate in tandem with pain severity, suggesting a possible link between symptom burden and neurocognitive function. Differential workup excluded reversible causes such as neurosyphilis, HIV, vitamin deficiencies, drug toxicities, and oral/dental pathology. This case highlights the potential neurobiological overlap between chronic pain syndromes and cognitive dysfunction and underscores the need to expand the clinical and research lens on BMS to include potential neurodegenerative components and highlights the importance of integrated, multidisciplinary care in complex chronic pain syndromes.