Pain in the back of my tongue

Tongue pain is commonly caused by lesions to the tongue, which can be due to infectious or a variety of non-infectious causes. Commonly, tongue pain symptoms are due to a viral infection or a non-infectious sore. Rarely, tongue pain is due to cancer or a serious allergic or hypersensitivity reaction. Some systemic medical disorders cause tongue pain without noticeable lesions on the tongue, including some autoimmune conditions or nutritional deficiencies. White coating, red blisters, or shallow ulcers on the tongue can all be associated with tongue pain. Some causes of tongue pain can be treated at home, but many of the infectious and systemic causes of tongue pain should be evaluated by a doctor.

Common accompanying symptoms of tongue pain

Symptoms that can be associated with tongue pain include:

• White coating on the tongue
• Sores, blisters, or lesions on the tongue
• Changes in tongue texture or appearance
• Sores or blisters on the inside of the cheeks or lips
• Bleeding from the tongue
• Fatigue
• Numbness or tingling in the arms and legs
• Facial rash
• Swelling to the tongue or lips

What causes tongue pain?

There are a variety of infections, mostly viral or fungal, that can cause painful lesions to the tongue. Some of these infectious agents are sexually transmitted, but others are not. Canker sores are a common, noninfectious cause of painful tongue lesions. Trauma or burns to the mouth are other common causes of tongue pain. Additionally, some systemic medical issues like nutritional deficiency, autoimmune disorders, or genetic syndromes can cause tongue pain symptoms. The most dangerous cause of tongue pain is a drug hypersensitivity reaction that usually involves a rash with swelling to the lips and tongue.

Infectious causes

Infectious causes may be to blame for your tongue pain.

• Viral infections: Many viruses including herpes, chicken pox, and HIV can cause painful lesions to the tongue and the inside of the mouth. These viruses are common, and some can be passed from person to person.
• Fungal infections: Fungal infection in the mouth is common, particularly in young children, elderly patients that wear dentures, and anyone with a compromised immune system. Typically, fungal infection is not passed from person to person.
• Sexually transmitted Infections: Painful lesions in the mouth can be a sign of some sexually transmitted infections, including HIV and syphilis.
• Herpetic stomatitis is a viral infection of the mouth that causes fever and red and inflamed gums.

Non-infectious causes

Non-infectious causes may also cause tongue pain.

• Burn: Eating or drinking something hot can cause a painful burn to the tongue or inside of the mouth.
• Trauma: Any trauma to the mouth or biting the tongue can cause pain. Patients with braces or dentures may experience pain due to friction from the device.
• Canker sores are round, shallow ulcers on the tongue and inside of the lips that can be very painful. These are not infectious and cannot be passed between people.
• Cold sore is a skin lesion on the lips caused by infection with the herpes simplex virus (HSV).
• Mucocele (mucous cyst) is caused by repeated biting leading to leakage of mucous from damaged mucous ducts, which accumulates and creates a cyst.
• Cancerous or precancerous lesions: Cancer to the tongue and mouth can cause painful lesions. Smoking or chewing tobacco and drinking alcohol greatly increase the risk of some types of oral cancer. Mucosal melanoma of the head and neck (MMHN) is a rare type of mouth cancer.

Medical causes

Other medical causes may result in tongue pain, such as the following.

• Nutritional deficiency: Some nutritional deficiencies can change the appearance and texture of the tongue, which may be accompanied by pain. Typically, nutritional deficiencies will have additional symptoms like fatigue, numbness or tingling in the limbs, or personality or mood changes.
• Autoimmune disease: Painful lesions on the tongue can be a symptom of several autoimmune conditions (conditions in which the immune system attacks the body).
• Genetic syndromes: Some inherited syndromes like Bechet's syndrome are characterized by recurrent painful oral lesions.
• Hypersensitivity or allergic reactions: Reactions to medications, food, or other allergens can cause swelling or painful rash that involve the lips, tongue, and inside of the mouth. Some of these reactions can be life-threatening.
• Burning mouth syndrome (BMS) is a chronic pain syndrome that causes burning pain or sensation in your mouth without a cause that can be found.

Tongue pain treatments and relief

Some causes of tongue pain symptoms will resolve on their own and can be managed at home. However, many infectious and systemic causes of tongue pain should be evaluated by a doctor for further workup and appropriate treatment. Anyone with significant swelling to the lips or tongue should seek immediate medical attention, as serious hypersensitivity and allergic reactions can be life threatening.

When tongue pain is an emergency

Seek emergency tongue pain treatment if:

• You have significant swelling to the lips or tongue
• You have any difficulty breathing

At-home treatments for tongue pain

You can try the following remedies at home for your tongue pain symptoms.

• Watching and waiting: In the event of minor trauma, burning, or biting the tongue may just need time to heal. The cells of the tongue turn over very quickly, so this usually only takes a day or two.
• Pain relief: Over-the-counter gels that you place on the tongue can provide relief from pain.
• Salt water rinse: Salt water rinse can provide pain relief and aid in healing when canker sores are the cause of tongue pain.

Medical treatments for tongue pain

If your tongue pain persists despite home remedies, you should consult your physician. He or she may recommend the following.

• Topical gels: Some causes of tongue pain, particularly those associated with fungal or non-infectious lesions, can be treated with topical medications. Additionally, topical numbing agents can be used to relieve pain.
• Antiviral medication: Many viruses that cause painful tongue lesions are treated with antiviral medications.
• Steroids: Some inflammatory causes of tongue pain are treated with steroids.
• Blood testing: If a doctor suspects nutritional deficiency or autoimmune disorder as the cause of tongue pain, they may suggest blood tests to help determine the cause.
• Biopsy: If a doctor is worried the tongue pain might be from a cancerous or precancerous lesion, they may suggest a biopsy. A biopsy is when a small piece of the lesion is removed and examined to determine if it is cancerous.

FAQs about tongue pain

Can allergies cause tongue pain?

There are many different causes of tongue pain, including infections, canker sores, trauma or burns, and systemic medical illness. Some allergic and hypersensitivity reactions can cause swelling to the lips and tongue that may be accompanied by tongue pain. Any significant swelling to the tongue or lips requires emergency medical attention, as allergic and hypersensitivity reactions can be life threatening.

Is tongue pain a symptom of STDs?

Tongue pain with or without blisters or ulcers on the tongue can be due to a variety of infectious and non-infectious causes. Possible infectious causes of tongue pain include viruses like herpes or chickenpox, as well as fungal infections like candida. Some sexually transmitted infectious can cause painful lesions to the tongue and inside of the mouth, including HIV and syphilis.

Why does my tongue feel like it's burnt?

While burns or trauma to the tongue can cause tongue pain, there are many other possible causes of a painful or burning sensation on the tongue. There are multiple infectious and noninfectious causes of painful lesions to the tongue, including canker sores, viral infections, and fungal infections. Often, lesions caused by the herpes virus or chicken pox virus cause a sensation in the tongue that is similar to a burn. Additionally, some medical conditions like autoimmune diseases or nutritional deficiencies can lead to tongue pain.

What are these blisters on my tongue?

There are multiple non-infectious and infectious causes of tongue lesions. Some infectious causes including viruses like chicken pox or herpes, and other and sexually transmitted infections. All of these infections have the ability to cause blisters, lesions, or sores on the tongue. Some non-infectious causes of tongue lesions include canker sores or malignant or premalignant lesions.

Can a sore throat give you a sore tongue?

Some infections, particularly viral infections, can cause painful lesions in the throat and the rest of the oral cavity, including the tongue. However, there are multiple infectious and noninfectious causes of sore tongue that should be considered. Canker sores, fungal infections, or medical conditions like autoimmune diseases or nutritional deficiencies can lead to tongue pain.

Questions your doctor may ask about tongue pain

• Where specifically is your mouth pain?
• Do you have a rash?
• Have you ever been diagnosed with HIV or AIDS?
• Does your breath smell worse than usual?
  

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.

Jeffrey M. Rothschild, MD, MPH.

Associate Professor of Medicine, Brigham and Women’s Hospital

Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...

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