DR MARTIN SCURR: Could anything relieve the burning pain in my mouth after getting Covid? 

For several months I have had a burning sensation on my tongue and lower gums. It seems to get worse as the day goes on. The doctor mentioned burning mouth syndrome but couldn’t suggest any treatment to help. It really gets me down.

Angela Simons, by email.

I’ve encountered this disturbing and painful complaint a number of times and the good news is that there are several treatments that have been proven to help – but first let me explore the probable cause.

The burning sensation may persist or, as in your case, increase throughout the day. Some people also experience dry mouth or a distorted sense of taste.

Despite often significant pain, oral examination will reveal no obvious cause.

This is known as primary burning mouth; “secondary” burning mouth is where an underlying condition, such as acid reflux or allergies, is causing the symptom.

You ask in your longer letter if perhaps Covid is to blame. In fact, at least one study has shown that burning mouth is linked to Covid; but it is very rare and usually occurs during or immediately after infection.

Your symptoms may very well go away: Research shows that 30 to 50 percent of patients with a burning mouth find that their symptoms go away on their own, but this can take months or even years.

However, there are medications that have been found to help. These include anticonvulsants, such as clonazepam (which also has a sedative effect, so perhaps acting on the brain’s perception of pain) and pregabalin or gabapentin (which act on nerve cell function and messaging).

Another option is another type of medicine such as pramipexole. Studies have shown that some people with a burning mouth have low levels of the brain chemical dopamine (which plays a role in pain regulation), and pramipexole stimulates dopamine receptors in the brain.

In a 2017 study of six patients (five of whom, like you, found their symptoms worsened as the day went on), all experienced relief from their symptoms with pramipexole, according to the report in the journal Neurologia. The improvement continued over a four-year follow-up.

I should point out that each of these medications carries the risk of side effects, including in the case of pramipexole, nausea, dizziness, and trouble sleeping – but you may decide that the trade-off to resolve your pain may be worth it.

I suggest you ask your GP for a trial to assess which of these treatments is most appropriate.

I gasp after putting away the groceries – sometimes I sink into a chair. I saw a doctor when this started 18 months ago and had an EKG and echocardiogram. Both were fine. I’m almost 90, but don’t feel like this is age related. I run a mile a day on a treadmill without gasping for breath.

Sheelagh Davidson, Belfast.

Your symptoms sound alarming and a diagnosis is essential as they are neither expected nor acceptable at age 90.

The episodes are all related to sudden physical exertion, when your muscles require a greater flow of oxygenated blood.

No doubt the cause lies with your heart and although you dismiss it in your longer letter, I think there is a good chance that you have aortic stenosis, a type of heart valve disease that reduces blood flow between the left ventricle of the heart. and the main artery or aorta.

Essentially, the aortic valve, which controls blood flow from the left ventricle, becomes stiff – it’s common at your age.

There may be no symptoms with moderate exertion, but a sudden, more forceful demand for blood flow can lead to acute shortness of breath (i.e., panting).

However, I would have expected this to have been seen on your echocardiogram. You may want to ask your GP specifically about the aortic valve and your echocardiogram results.

Aortic stenosis results in a unique pulse so your GP can identify it. If this diagnosis is confirmed, you can rest assured that the valve can be replaced, with a minimally invasive procedure, through the large artery at the top of your leg, known as a TAVI procedure. The results of this are excellent.

I think… Chronic fatigue link with intestinal problems

Ever since chronic fatigue syndrome — or myalgic encephalomyelitis — was identified in the 1980s, its cause has been a mystery.

But new research suggests it could stem from a disorder of the gut or, specifically, the microbes that live there.

A study in the journal Cell Host & Microbe revealed that patients with chronic fatigue syndrome have lower levels of certain types of bacteria in the gut compared to healthy people.

One of these bacteria is crucial for gut health, another produces short-chain fatty acids (the building blocks of fat), which have an anti-inflammatory effect.

It could be that the shortage of these bugs is causing the disease, rather than causing it, but the finding at least opens a path to a treatment, which is cause for cautious optimism for people with the condition.

Write to Dr. Scurr

Write to dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk — add contact details. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context. In case of health problems, consult your own doctor.