Why does my mouth feel on f ire?
Q I feel as if my mouth, tongue and lips are on fire. I suffer from this constantly and it’s so painful at times, but it seems that no one can do anything to ease the burning. Food just doesn’t have any taste now, and nor does any drink. It’s a horrible condition. Is there any advice you can give me?
A These symptoms would seem to indicate burning mouth syndrome, a recognised medical complaint where the tongue, gums, lips and palate can all feel as if they have been scalded.
For some people it comes and goes, while for others it remains constant and is terribly distressing. As well as the troubling burning, it can affect taste, causing food to seem bitter, or a complete loss of taste sensation.
There is usually no identified cause for the syndrome and this can only add to the distress of sufferers burdened with a complaint that’s seemingly come out of nowhere.
It is important to seek medical advice from a GP or dentist to eliminate treatable conditions that may be the cause or an exacerbating factor.
This would include oral thrush, deficiencies such as iron or B12, acid reflux or side effects from certain medications.
Other specific mouth conditions also need to be ruled out.
Doctors and dentists would agree that it is a very difficult condition to treat and we can only rely on symptomatic relief, meaning pain management.
Appropriate pain control would be nerve-blocking painkillers such as gabapentin or amitriptyline, which we typically use for burning pain.
Specific mouthwashes and local anaesthetic sprays can be of value, as well as saliva-replacement products to control the feeling of dryness that often accompanies the syndrome.
In order to control pain syndromes such as this, it is not unreasonable in addition to try a psychological approach, while anti-depressants can be very valuable.
Q My husband had a mini-stroke in 1993 and over the years has been prescribed various medications for an irregular heartbeat and diabetes.
The diabetes drug gave him a terrible rash, so he has been prescribed three other medicines to control that.
Surely they ought to be looking for an alternative first treatment, rather than prescribing more tablets to cope with the side effects of the first lot? A It’s bad enough being ill in the first place and being put on medication. So being made to feel ill in a different way from a treatment used to combat the initial problem is particularly difficult for patients.
Someone who is diabetic, for instance, may well have other medical complaints such as high blood pressure, and will find themselves on two or maybe three medications for the primary problems.
Patients can go from nothing to taking numerous tablets every day in a short space of time.
The reason any drug is given is because we know the benefits vastly outweigh the risks. But the side effects from multiple drugs can really affect quality of life. It is a problem we doctors are acutely aware of, but are often unable to avoid.
One course of action is to give further treatment to combat the side effects. In many cases, this is the most effective intervention. But if symptoms persist, if a patient is on four, five or more different pills, it can be tricky to determine which drug is actually to blame.
Rashes are one of the most common side effects of medications.
But given the huge benefits gained from in preventing catastrophic events such as a stroke, if a rash were only mildly troubling and well controlled with creams, it would be considered a small price to pay.
If the rash or any side effect is more agitating or problematic, medicines do need to be stopped in turn to isolate the cause and rethink.
Be organised, go back to your GP, communicate clearly, and make sure you don’t stop or start anything without their full say-so.
And remember, it is always worth considering with side effects that they may in fact not be side effects, but unconnected symptoms that happen to start contemporaneously.