Painful swallowing is treated by addressing what is causing the underlying problem (such as antibiotics for strep throat) and with symptom relief.
Painful Swallowing
Heather M. Jones is a freelance writer with a focus on health, parenting, disability, and feminism.
Published on February 02, 2023
Kimberly Brown, MD, MPH is an emergency medicine physician, speaker, and best-selling author.
Table of Contents
Table of Contents
Painful swallowing can feel like discomfort or pain or may feel like a burning or squeezing sensation. It may be felt anywhere from the neck to the breastbone. Pain in the throat or chest during swallowing is called odynophagia .
Painful swallowing can be caused by several things, including infection, acid reflux, or damage to the esophagus (food tube). This article will discuss what can cause painful swallowing, when to be concerned, and what to do about it.
Yurii Yarema / Getty Images
Symptoms of Painful Swallowing
In addition to pain or discomfort while swallowing, a person with odynophagia may also experience:
- Soreness or ulcers in the mouth
- Pain and a burning sensation after swallowing
- Feeling as though food is “stuck”
- Reflux (stomach acid flows back into the food tube) or indigestion
Painful swallowing often feels like a sensation of squeezing or burning. It may be felt high in the neck or down lower behind the breastbone.
Medical Emergencies
Sudden symptoms of difficulty swallowing can indicate a condition that is a medical emergency, requiring calling 911 or getting immediate transport to an emergency room. These include:
- Stroke: Signs of a blockage of blood flow or bleeding in the brain can include sudden difficulty or inability to swallow, weakness or drooping of one side of the face or body, speech difficulties, vision loss, dizziness, confusion.
- Angioedema: Swelling of the lower layer of tissue under the mucous membranes in the mouth and throat can cause difficulty swallowing. It can be a medical emergency as it may impact breathing. It may be accompanied by lip and tongue swelling, hoarse voice, drooling, and more.
Causes of Painful Swallowing
Painful swallowing can be caused by many different things, including:
Infections, such as:
- Sore throat from a virus such as a cold or flu
- A bacterial infection such as strep throat
- Herpes simplex virus
- A gum or tooth infection or abscess
- Cytomegalovirus (closely related to the viruses that cause chickenpox and mononucleosis )
- Candida albicans (fungal infection commonly called thrush usually affecting the mouth but can affect the esophagus, particularly in people with a compromised immune system)
- Tonsillitis (infection of the tonsils)
- Peritonsillar abscess (an area of pus-filled tissue at the back of the mouth beside one of the tonsils)
- Middle ear infection (otitis media)
Conditions affecting the mouth, throat, or esophagus, such as:
- Gastroesophageal reflux disease (GERD) (when acidic stomach contents flow back up into the esophagus)
- Esophagitis (inflammation and irritation of the lining of the esophagus)
- Esophageal spasms
- Nutcracker esophagus (powerful swallowing contractions, often caused by gastroesophageal reflux)
- Gingivitis (gum disease)
- Ulcers (sores) in the mouth, esophagus, or throat
- Laryngitis (inflammation of the larynx/voice box causing swollen vocal cords)
Damage to the mouth, esophagus, or throat, such as:
- An object or food stuck in the throat
- Scratches, tears, cuts, or irritation in the mouth, throat, or esophagus
- Burns
What Medications Can Cause Painful Swallowing
Some medications may cause ulcers in the esophagus, including:
- Tetracyclines (antibiotic)
- Aspirin
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil/Motrin (ibuprofen) and Aleve (naproxen)
How to Treat Painful Swallowing
Painful swallowing is treated by addressing what is causing the underlying problem (such as antibiotics for strep throat) and with symptom relief.
Ways to help relieve painful swallowing symptoms include:
- Changing eating habits, such as eating soft foods and avoiding foods that are very hot or very cold
- Not smoking, which can irritate the throat
- Using over-the-counter (OTC) lozenges or throat sprays
- Using a local anesthetic containing lidocaine (spray or oral solution) to numb the throat
- Pain management with Tylenol (acetaminophen) or NSAIDs
Eating Tips for Painful Swallowing
Changes you can make to your diet and habits to make eating with painful swallowing easier include:
- Choose soft/moist foods and foods that are easier to chew and swallow.
- Finely chop, mince, blend, or puree foods to soften them.
- Have beverages with your meal and sip as you eat to moisten your mouth and help the food go down.
- Use a straw if your mouth is irritated.
- Add moisture to foods by using sauces, gravies, etc., or dipping foods into warm drinks or soup.
- Avoid or soften crunchy, dry, or abrasive foods, such as chips, cookies, nuts, etc.
- Avoid foods that sting or irritate your mouth or throat. This may include salty or spicy foods, acidic foods like fruit/vegetable juice or vinegar, extremely hot or cold food and drinks, and alcohol.
If painful swallowing is causing you to eat less and lose weight, try these tactics:
- Eat smaller, more frequent meals.
- Add foods that are higher in protein or fats.
- Drink smoothies, milkshakes, or supplement drinks.
Complications Associated With Painful Swallowing
In addition to complications from the cause of the painful swallowing, ongoing pain while swallowing can lead to:
- Lack of adequate food and fluid intake
- Unintentional weight loss
- Reduced physical wellness and quality of life
Are There Tests to Diagnose the Cause of Painful Swallowing?
If you are experiencing painful swallowing, a healthcare provider will first do a physical examination and ask some questions about your symptoms and medical history. They may ask about the following:
- The nature of the pain (is it constant, does it come and go, is it getting worse, etc.)
- How the pain feels (sore throat, feeling like there is a lump in your throat, etc.)
- How it affects swallowing (pain when swallowing liquids, solids, or both)
- The circumstances surrounding the pain (such as have you swallowed or inhaled any irritating substances)
- Any other symptoms you may have
- Other health problems you have
- Any medications you take
If your healthcare provider feels it’s necessary, they may run tests such as:
- Tests for strep throat: A rapid antigen test is common, or a throat culture may be performed.
- HIV testing: This tests for the human immunodeficiency virus.
- Endoscopy: A flexible tube with a light and camera is used to look inside the body and sometimes remove tissue (biopsy) to analyze in the lab.
- Barium swallow and upper gastrointestinal (GI) series: A drink containing barium is swallowed then X-rays are performed.
- Chest or neck X-ray
- Esophageal pH monitoring: This test measures acid in the esophagus.
- Esophageal manometry : This test measures pressure in the esophagus.
- Esophagogastroduodenoscopy (EGD): An endoscope is used to examine the lining of the esophagus, stomach, and first part of the small intestine.
When to See a Healthcare Provider Painful Swallowing
Contact a healthcare provider if your painful swallowing is prolonged, is bothering you, or is accompanied by:
- Blood in your stools (or your stools appear black or tarry)
- Shortness of breath
- Wheezing
- Light-headedness
- Weight loss
- Fever
- Chills
- Abdominal pain
- Cough
- Nausea or vomiting
- Heartburn
- Sour taste in the mouth
Can Painful Swallowing Be a Sign of Cancer?
- Dysphagia (difficulty swallowing)
- Indigestion or heartburn that doesn’t go away
- Unexplained weight loss
- Pain in the throat or behind the breastbone
These symptoms can be caused by many more common conditions than esophageal cancer. If you have any of these symptoms, see a healthcare provider to have them checked.
Other symptoms of esophageal cancer include:
- Food coming back up
- Hoarseness
- A cough that won’t go away
- Coughing up blood
- Dark (almost black) stool (uncommon)
Summary
Painful swallowing is a symptom that can have many different causes, including infection, medical conditions such as GERD (gastroesophageal reflux disease), and damage from objects stuck in the throat.
Painful swallowing can be felt anywhere from the neck to the breastbone. It may feel like pain, discomfort, burning, or a squeezing sensation.
Painful swallowing is a common symptom of many different conditions. See a healthcare provider if you are experiencing unexplained painful swallowing or if the pain while swallowing isn’t going away or is accompanied by other symptoms.
Treating the underlying cause is the most important way to treat painful swallowing. Symptoms can be relieved by changing eating habits, using lozenges or numbing sprays/oral solutions, or taking pain medication such as NSAIDs.
Frequently Asked Questions
Is painful swallowing a sign of COVID-19?
Yes. A sore throat and/or painful swallowing can be a symptom of COVID-19. As with other COVID symptoms, if you are experiencing a sore throat and/or painful swallowing, it’s a good idea to take a COVID test.
How can I ease the pain from swallowing with a sore throat?
Changing what and how you eat can help, such as eating softer foods and chewing thoroughly. You can take pain relievers such as Advil or Motrin (ibuprofen). Throat lozenges may help, and there are both prescription and over-the-counter numbing sprays and oral solutions which may provide temporary relief. Be careful eating when using numbing agents as these products can increase the risk of choking, and you may not feel that something is too hot or cold. Numbing agents can also have side effects. Check with a healthcare provider or pharmacist before using them.
Is painful swallowing a medical condition?
Painful swallowing is not a condition in and of itself, but a symptom that can be caused by a number of different medical conditions. The medical term for painful swallowing is odynophagia.
17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Heather Jones
Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.
Why Does It Hurt to Swallow?
There are many reasons why you might feel pain when swallowing. Most likely, it’s something like an infection or a pill that went down the wrong way, though there can be more serious reasons.
You might feel the pain anywhere inside your mouth, your throat, along your esophagus (the tube that leads to your stomach), or even in the center of your chest. Here are some causes, but you’ll need to see your doctor to find out exactly what’s going on.
Cold, Flu, or Sinus Infection
A sore throat that causes painful swallowing often signals that you’re getting one of these common illnesses. It can start a day before other symptoms like a runny nose and cough.
If it’s a cold, you’ll need to wait it out by sipping fluids and getting plenty of rest. If it might be the flu, which feels much worse and is a lot more serious than a cold, you need to see a doctor.
With a sinus infection, constantly trying to clear your throat of drainage can cause irritation and painful swallowing until the infection clears.
Strep Throat
Often just called strep, this bacterial infection can be very painful. Other telltale signs of strep are not having the usual symptoms of a cold and not having a cough.
When a grown-up gets strep, the symptoms are usually a sudden sore throat, possibly with a fever, and swollen lymph nodes in your neck. Children ages 3 and older can have fever, nausea, and vomiting along with a sore throat. Kids younger than 2 usually don’t get strep.
See your doctor for a rapid strep test or a throat culture, which can find infections that the fast test sometimes misses. Antibiotics are the usual treatment. While it will go away on its own, treatment is recommended to feel better, prevent it from spreading to other people, and prevent complications.
Mono
This infection caused by the Epstein-Barr virus is easy to get — and to spread. In addition to pain when swallowing, you might also have these symptoms: fever, headache, swollen tonsils and lymph nodes, muscle aches, and fatigue.
You’ll need to take a blood test to diagnose mono. Most people feel better over time without special treatment, and your doctor will keep an eye on your health to make sure you don’t have any complications.
Herpes Simplex Virus
Type 1 of this virus can cause sores inside your mouth (as well as along the lips) and pain when swallowing. The sores go away in a few days, but call your doctor if this is your first outbreak or if you have HIV. While you’re recovering, skip acidic foods like citrus, get enough rest, and try to avoid stress to feel better.
Thrush
This yeast infection is common in people with HIV, but you’re also at risk for it if you have diabetes or a disease of the esophagus, take certain steroids, take antibiotics, or use steroid inhalers for asthma. If thrush is the cause, you might also have these symptoms: loss of taste, a cotton-like feeling in your mouth, and dry, cracked, red skin at the corners of your lips.
See your doctor for treatment, which will probably mean taking an antifungal drug.
CMV
Part of the same virus family that causes herpes and mono, cytomegalovirus can switch between active and quiet periods. If CMV is the cause, you might also have these symptoms: fatigue, muscle aches, fever, nausea, and vomiting. Eating well and getting plenty of rest will help your body fight the infection, but see your doctor if you’re pregnant or have HIV or a weakened immune system since CMV can be particularly serious for you.
Swallowing Pills or Food
You don’t want anything to stick to and irritate your esophagus. Small, oval, and heavier pills pass through more easily than large, round, and lighter ones. The medications most likely to cause problems are antibiotics like doxycycline and tetracycline, potassium supplements, and NSAIDs. (It can happen if you swallow a jagged piece of food, too.)
To prevent this, have at least a half-cup of water when you take a pill, and sit up straight for at least 10 minutes afterward. If it’s a medicine known to irritate, drink a cup of water and don’t lie down for at least 30 minutes.
GERD
GERD is gastroesophageal reflux disease. If you have it, you might also have these symptoms: heartburn with pain in the chest and throat, an acid taste in your mouth, vomiting, trouble swallowing, and a hoarse voice. The painful swallowing can happen if the acid reflux eats away at the lining of your esophagus.
See your doctor if you have heartburn two or more times a week. Changes to your diet may help, along with GERD medication.
Crohn’s Disease
It’s rare for Crohn’s to affect your esophagus (it usually affects the colon), but it can happen anywhere along the digestive tract, starting in your mouth or esophagus. You may find it both hard and painful to swallow.
If you have Crohn’s, you might also have these symptoms: diarrhea and cramping, weight loss, and poor appetite. Tell your doctor what’s going on. You may need to get a test called an endoscopy to look for ulcers in your esophagus.
Some Cancers and Cancer Treatments
Painful swallowing isn’t likely to be cancer. But it can be a symptom of throat and esophageal cancers. You might feel pain when swallowing as a tumor grows and the passageway gets narrower.
If you’ve had this symptom for a while and you’re starting to feel like you need to eat soft food in tiny bites, see your doctor. You may need to get an imaging test of the upper part of your digestive system.
Some treatments for various types of cancer can also make it hurt to swallow. Chemotherapy or radiation to the head, neck, or upper chest can inflame the lining of the mouth, throat, or esophagus. Other symptoms include dry mouth or swelling. If you’re having these problems while you get your cancer treatment, try eating softer foods, blender drinks, soups, and purees. Also, cold foods can be soothing, while very spicy foods can hurt more. This pain should stop soon after you’re done with your cancer treatment.
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