Painful Swallowing (Odynophagia)

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Published: August 2, 2017
Last reviewed: August 2, 2017

What is painful swallowing?

Painful swallowing or, medically, odynophagia, is any pain felt in the throat or chest during swallowing.

Causes

Causes of painful swallowing can be divided into:

  1. Conditions with THROAT PAIN
  2. Conditions with CHEST PAIN

Chart 1. Conditions With THROAT PAIN During Swallowing

SYMPTOMS CAUSES
A feeling of a lump in the throat, dry cough, hoarseness, metallic taste
  • Foreign body (fish bone, sunflower seeds[9]
  • Laryngopharyngeal reflux [12]
  • Throat cancer [27]
Sore throat with white spots, fever, swollen neck lymph nodes
  • Strep throat [9]
  • Oral thrush [9]
  • Viral infection: Herpes, HIV
Muscle pain in the upper back, neck stiffness
Sudden, sharp pain in the ear, tongue and throat on the right or left side during swallowing, talking or yawning
  • Temporomandibular joint dysfunction
  • Glossopharyngeal neuralgia – a compression of the 9th cranial nerve by a brainstem tumor, blood vessel or bony process (Eagle syndrome) [15]
  • Carotidynia – a sensitive carotid artery [6,9]

Chart 2. Conditions With CHEST PAIN During Swallowing

SYMPTOMS CAUSES
Heartburn, difficulty swallowing, foods stuck in the chest Esophageal ulcers due to:

  • Acid reflux [3]
  • Infections with Candida or Herpes virus (in AIDS, chemotherapy) [3,4]
  • Crohn’s disease [4]
  • Pills (aspirin, ibuprofen, tetracycline, steroids, iron, vitamin C, potassium chloride) [8,13] or caustic liquids [3]
  • Eosinophilic esophagitis in asthma or food allergy [10]
  • Radiation therapy [3]
Severe chest pain triggered by cold beverages, red wine or stress (also between meals), difficulty swallowing solids and liquids, heartburn Esophageal spasms: diffuse spasm, nutcracker esophagus [5,11,19,20]; scleroderma [9]
Anorexia, weight loss Esophageal cancer [3]
Vomiting blood, black stools Mallory-Weiss syndrome – a rupture of the esophageal wall due to forceful vomiting (in chronic alcoholics) [16,18]

Can be chest pain during swallowing a sign of heart disease?

Chest pain during swallowing more likely results from an esophageal problem (food impaction, acid reflux, infection, spasm) than from coronary heart disease. Note, that in both esophageal spasms and heart disease (angina pectoris) chest pain can be triggered by large meals, anxiety and exercise [23].

Diagnosis and Treatment

If you suffer from painful swallowing that does not seem to arise from a simple condition, such as mild throat infection, visit a doctor. You might need a referral to a specialist, such as a dentist, an ENT doctor, gastroenterologist or neurologist. More details about investigations and treatment of swallowing problems are in the article about difficulty swallowing (dysphagia).

Home Remedies

To prevent or limit painful swallowing:

  • Have small meals, eat slowly and chew food well.
  • Avoid dry, rough, spicy and very hot or cold foods.

When you experience severe chest pain during swallowing due to esophageal spasm, try the following to release the food that has stuck in your esophagus [3]:

  • Pinch the nose with the fingers and blow air through it (Valsalva maneuver) [25].
  • In diffuse esophageal spasm or achalasia, drinking some carbonated [5] or warm/hot water [11,22] can relieve pain.
  • In one small study, adding peppermint oil extract in water helped relieve pain in diffuse esophageal spasm [24].

Drinking HOT or CARBONATED beverages can:

  • Relieve chest pain in achalasia and diffuse esophageal spasm [5,22]
  • Aggravate chest pain in acid reflux, esophageal infection or nutcracker esophagus [20]

  • References

      1. Cohen MD et al, 1982, Facial swelling and giant cell arteritis  PubMed
      2. Spechler S, 2013, Approach to the patient with dysphagia  Clinical Advisor
      3. Richter JE, Dysphagia, odynophagia, heartburn and other esophageal symptoms  University of Alberta
      4. Janssens C et al, 1991, Odynophagia is less of a problem, as there is a clear relation between pain and swallowing  HON.ch
      5. Mohammed SH et al, 1986, Dislodgement of impacted oesophageal foreign bodies with carbonated beverages  PubMed
      6. Comacchio F et al 2012, Carotidynia: new aspects of a controversial entity  PubMed Central
      7. Alafaci C et al, 2015, Glossopharyngeal neuralgia caused by a complex neurovascular conflict: Case report and review of the literature  PubMed Central
      8. Spieker MR et al, 2000, Evaluating dysphagia  American Family Physician
      9. Richmon JD et al, Odynophagia  Ento Key
      10. Eosinophilic esophagitis  American Academy of Allergy, Asthma & Immunology
      11. Esophageal spasms and strictures  Cleveland Clinic
      12. Lechien JR et al, 2016, Impact of laryngopharyngeal reflux on subjective and objective voice assessments: a prospective study  PubMed Central
      13. Medications and dysphagia/swallowing risks  CT.gov
      14. ES Information: Common Symptoms And Possible Explanations For Them  Livingwitheagle
      15. Singh PM et al, 2013, An uncommonly common: Glossopharyngeal neuralgia PubMed Central
      16. Fishman S et al, 2012, Pain Conditions, Bonica’s Management of Pain, p. 1058
      17. Very strange back pain when I swallow  Steady Health
      18. Mallory-Weiss tear  BMJ Best Practice
      19. Esophageal spasms risk factors  Mayo Clinic
      20. Esophageal spasms, clinical presentation  Emedicine
      21. Esophageal spasms, treatment & management  Emedicine
      22. Moo in Park, 2011, Hot Water Swallows May Improve Symptoms in Patients With Achalasia  PubMed Central
      23. Lynch KL, Symptomatic Diffuse Esophageal Spasm  Merck Manual
      24. Pimentel M et al, 2001, Peppermint oil improves the manometric findings in diffuse esophageal spasm
        PubMed
      25. Spieker MR et al, 2000, Evaluating dysphagia  American Family Physician
      26. Common Voice and Swallowing Problems  OHSU
      27. Pharyngeal cancer symptoms  Cancer Treatment Centers of America

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