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Bizarre Case of Mouth Pain, With an Explanation and a Solution (Member Post)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Today I have a quick clinical story from my own recent experience with a strange, nasty mouth pain … and surprisingly obvious explanation, and easy solution.

Unfortunately, this was yet another case of my own strange problems with pain giving me exciting new ways to relate to my readers. This incident nuked a night of sleep, but there was a delightful ending despite that: a surprising diagnosis and a totally effective treatment.

But the ending is the first thing I’m going to share only with premium subscribers/members. The paywall is up.

Fortunately, the setup for that ending is quite interesting too. Clinicians, feel free to speculate: what on Earth do you think I found in my mouth? Comment on this post on Twitter or Facebook.

The setup: ominous throat soreness

My wife and I were binging Vikings, catching up with previous seasons before finally watching the long-delayed sixth season. While watching before bed, I noticed a bit of a sore throat, a bit of a “tickle.” In pandemic times, who isn’t a bit freaked out by that maybe-my-throat-is-sore feeling? The threat of COVID is significant even for the fully vaccinated, intimidating even when it doesn’t hospitalize, cripple, and kill. And breakthrough cases were always expected — the vaccines were built to blunt the symptoms, not to stop infection.

And two nights earlier I’d had dinner with someone in a crowded restaurant, indoors, for the first time since the pandemic started. So my immediate reaction to that weird throat feeling was a clear, “Uh oh.” This is exactly how it starts. (See ”What does getting Covid feel like for the fully vaccinated?” Three good case studies.)

I didn’t panic, because this is not my first rodeo, and it’s my not-so-new-normal for my body to shower me with bizarre symptoms (ever since 2015). Sadly, I’m used to this kind of thing.

But COVID was certainly on my mind as I went to bed.

The weirding: from sore throat to sore face

Even as my head hit the pillow, it started to seem more like my mouth hurt than my throat. The pain was starting to come into focus, dominating the right side of my soft palate. This is the main pain that I endured all night, and it was too far forward to be a classic sore throat. But I couldn’t imagine what else the problem could be, and it reached just far back enough to sustain the fear of a throat thing.

Painful swallowing woke me up each time I started to drift off. The fear of COVID was downgraded… and replaced by fear of a more ominous infection. Something mean, spreading fast.

My pain story is all about enduring a disturbing variety of aches and pains, and this was one of the worst on record: fast, fierce, and strange. By 5am I was a wreck from sleep loss and anxiety. My soft palate felt badly bruised. The whole right side of my face throbbed.

The surprising explanation and solution

I don’t know why I waited all night to look in my mouth. I should have done it sooner. I might have saved the night. Around dawn, when I did get a flashlight and take a look in the mirror, I was quite startled by what I found:

  • An obvious sign of the problem. A blatant, unmistakable, holy-crap-look-at-that sign.
  • And it was a sign that suggested an easy fix… which actually worked. The pain was completely gone less than a minute later, and it didn’t come back.

So what did I find in my mouth?!

My medial pterygoid muscle, standing out in sharp relief. The medial pterygoid is kind of like the masseter muscle, but smaller and on the inside of the temporomandibular joint, instead of the outside. You can see where it is normally — under the mucosa behind the molars. But it’s not normally visible like a bulging muscle.

Mine was: a dramatic bridge of tissue, a hard cord standing well out from the normal surface of the tissue, dramatically changing the contours of the area, as obvious as a flexed biceps muscle. Completely and obviously different from the other side.

It was cramping. It was obviously contracted.

My first thought: cause or symptom? Maybe it was just cramping as a reaction to the painful situation. Seeing the state it was in was certainly interesting, but it was hardly reassuring.

Rubbing it out

The medial pterygoid may be at the back of the mouth, but it’s easy to reach. I reached in and pressed on it. It felt like a bowstring, and was exquisitely sensitive. Gentle pressure made my soft palate light up with the same pain that had driven me nuts all night… and it also spread, less dramatically, to the teeth, jaw, and cheek.

I had never once bee conscious of pain at the location of the muscle itself.

I rubbed it gently for about 30 seconds. It was an great relief, as clearly helpful as stretching out a cramping calf muscle.

It visibly softened as I watched, fading into the mucosa like Homer simpson backing into the hedge.

The cramp was gone. The pain was gone. It did not come back. That was simply the end of it — like I’d flipped a switch.

Some reactions to this odd experience

  1. How many other strange aches and pains, some of them causing intense suffering, have similar causes that we can’t see? Or rub?
  2. The proximate cause of this pain was clearly distressed muscle tissue. It is completely unclear why the muscle was in that state. There could be any number of deeper explanations, some of them ominous (e.g. neuropathy). But the tissue that actually hurt was muscle.
  3. We could certainly call this a “trigger point,” because that’s the widely accepted informal label for exquisitely sore spots in soft tissue. But the every bit of the muscle that I could touch was sore. I am unclear if the cramping tissue was the entire muscle, or just one patch of fibres, the infamous “taught band” associated with trigger points.
  4. Massage for the win! Holy crap! It was so little massage it barely even qualifies. Such a dramatic and quick result is consistent with a widely held belief that “fresh” trigger points are more tractable.

Where's your trigger point skepticism now, buddy?

I have my doubts about trigger point therapy, as any rational person should if they are familiar with all the rank bullshit that pollutes the field of massage therapy. Trigger point therapy gets badly overhyped.

I have even doubted my own best anecdote about being helped by trigger point therapy. It was almost a quarter century ago, and it was extremely similar to this one — an incident that took place only a centimetre away in my face from this one. I had a terrible toothache. I was miserable and had a dentist appointment the next morning. I fully expected it to be a rotting tooth.

By sheer chance, I had a massage therapy appointment first — and my massage therapist fixed my toothache completely … by rubbing my jaw.

In the many years since then, as a hardened skeptic prone to questioning my own perceptions, I have come to doubt that story. It had faded into dubious legend. After this experience with my medial ptergyoid, its credibility seems restored to me. That really happened, and so did this.