Unraveling Mysterious Tongue Pain: A Neurological Perspective

Q: Unraveling Mysterious Tongue Pain: A Neurological Perspective

Hello, Sir： The issues you mentioned may be related to rheumatologic and immunologic disorders. <br>It might be worth considering Behçet's Disease, which has the following major diagnostic criteria： recurrent oral ulcers, skin lesions such as erythema nodosum, subcutaneous venous

Strange and puzzling medical conditions?

Three years ago, after drinking a bottle of Pom juice one night, I started experiencing pain in my tongue.
At that time, several areas were red but without any sores, and the pain persisted.
I went to a teaching hospital for an examination, where both the attending physician and the chief physician evaluated me.
I was mentally prepared for a biopsy, but the attending physician just glanced and immediately deemed it normal (the chief physician, however, examined me seriously and seemed to perceive me as a neurotic).
Later, I ignored their opinions, and most of the painful areas healed on their own, although the condition fluctuated between good and bad.
I lost track of how many times it flared up.
I then went to a clinic for answers.
This spring, it flared up again.
Due to the pandemic, I only dared to visit a clinic where the doctor conducted a thorough physical examination and said everything was normal.
Now, in the fall, I notice that I might be pain-free for three days, followed by two days of pain.
This pattern continues, with one month being normal and the next month flaring up.
I use a flashlight to examine the painful or heated areas, but there are no visible sores.
However, the affected areas seem to have atrophy, resembling geographic tongue, but without redness or swelling.
Interestingly, I have irritable bowel syndrome, and if my gastrointestinal tract is uncomfortable, the tongue pain increases; conversely, it alleviates when my gut feels better.
My personal BMI is only 18, and I have been thin since my youth.
Could my intestines be affecting my tongue? What could be the cause of my condition?

Niming, 30~39 year old female. Ask Date: 2021/09/19

Dr. Jiang Junyi reply Neurology

Hello, Sir: The issues you mentioned may be related to rheumatologic and immunologic disorders.
It might be worth considering Behçet's Disease, which has the following major diagnostic criteria: recurrent oral ulcers, skin lesions such as erythema nodosum, subcutaneous venous vasculitis, folliculitis, acneiform lesions, and skin hypersensitivity (Patergy test); ocular involvement including iritis and retinitis; a confirmed history of iritis and retinitis; and genital ulcers (primarily on the scrotum in males and on the labia in females).

The secondary diagnostic criteria include arthritis without deformity or ankylosis, gastrointestinal involvement, particularly ulcers at the ileocecal junction, epididymitis, vascular lesions, and central nervous system involvement.
Additionally, vitamin B12 deficiency could also present with your symptoms.

I recommend consulting with a neurologist or a rheumatologist for further assistance.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2021/09/19

More Info

Your situation regarding the mysterious tongue pain is indeed complex and multifaceted. Based on your description, it appears that you have been experiencing recurrent episodes of tongue pain, which may be associated with various factors, including gastrointestinal issues and possibly neurological components.
Firstly, it is essential to understand that the tongue is innervated by several cranial nerves, primarily the hypoglossal nerve (CN XII) for motor function and the trigeminal nerve (CN V) for sensory function. The pain you are experiencing could be related to irritation or dysfunction of these nerves. Additionally, the tongue's sensitivity to pain can be influenced by various factors, including inflammation, infections, or even systemic conditions.

The phenomenon you described, where your tongue pain correlates with gastrointestinal discomfort, suggests a potential connection between your digestive system and oral health. This relationship is not uncommon; gastrointestinal issues can lead to changes in the oral cavity, including inflammation or alterations in the mucosal lining of the tongue. For instance, conditions like gastroesophageal reflux disease (GERD) can cause acid to irritate the throat and tongue, leading to discomfort.

Moreover, you mentioned experiencing a condition resembling "geographic tongue," which is characterized by irregular patches on the tongue's surface that can change over time. Geographic tongue is generally considered a benign condition, but it can be associated with certain triggers, including stress, hormonal changes, and dietary factors. It is also worth noting that individuals with gastrointestinal disorders, such as irritable bowel syndrome (IBS), may have a higher prevalence of geographic tongue.

Your observation that the pain fluctuates, with periods of relief and exacerbation, could indicate a chronic pain syndrome, which may involve both peripheral and central nervous system components. Chronic pain can sometimes lead to changes in how the nervous system processes pain signals, resulting in heightened sensitivity in certain areas, including the tongue.

Given the complexity of your symptoms, it is advisable to pursue a multidisciplinary approach to your care. Here are some recommendations:
1. Consult a Neurologist: Since your symptoms may have a neurological component, a neurologist can help assess for any underlying nerve issues or conditions that may be contributing to your tongue pain.

2. Gastroenterologist Evaluation: Given your history of IBS and the correlation between gastrointestinal discomfort and tongue pain, consulting a gastroenterologist may provide insights into managing your digestive health, which could, in turn, alleviate your oral symptoms.

3. Oral Examination: A thorough examination by an oral specialist or dentist may help rule out any local oral conditions that could be causing your symptoms.

4. Dietary Considerations: Keeping a food diary to identify any potential dietary triggers for your tongue pain may be beneficial. Certain foods, particularly acidic or spicy items, can exacerbate oral discomfort.

5. Stress Management: Since stress can impact both gastrointestinal and oral health, incorporating stress management techniques such as mindfulness, yoga, or cognitive-behavioral therapy may help reduce the frequency and intensity of your symptoms.

6. Pain Management: Discussing pain management strategies with your healthcare provider can help address the discomfort you experience during flare-ups.

In summary, while your tongue pain may seem isolated, it is likely interconnected with your gastrointestinal health and possibly neurological factors. A comprehensive evaluation by specialists in neurology and gastroenterology, along with a focus on oral health, will be crucial in unraveling the underlying causes of your symptoms and developing an effective treatment plan.

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