Chronic Neck Pain Unexplained by Scans: Seeking Guidance
I’m a 29-year-old female, standing 5'6" and weighing 145 pounds. My daily regimen includes 500mg of Valacyclovir, which I've been taking for over three years. I don’t smoke or drink heavily, but I struggle with several medical issues, including persistent back pain, TMJ dysfunction (TMJD), and a mysterious stabbing pain in my neck. Approximately two years ago, I received a diagnosis of TMJD. However, I have come to the realization that this condition may not be the root cause of my discomfort. The primary issue I face is a stabbing, localized pain that occurs beneath my jawline, in the upper neck, primarily on the right side, which becomes tender to the touch. Although I also experience pain in my jaw and facial area on the same side, it is notably less severe than the pain in my neck. This neck pain tends to be a constant presence unless I manage it with Aleve or Tylenol—both of which have become part of my daily routine over the past two years. While heat packs provide some relief, their effectiveness diminishes quickly once they cool down. On a daily basis, I endure intense pain that can spike to a level of 9 out of 10, linger for an hour, then recede to about a 6 for a few hours before flaring up again. In my search for relief, I consulted a TMJ specialist, operating under the belief that my pain was rooted in TMJD. After a month and a half of treatments yielded no improvement, he examined my neck more thoroughly, applying significant pressure to the area. The discomfort was overwhelming; I ended up in tears and nearly leaping from my seat. During this examination, he located a small mass on the right side beneath my jaw. He described it as roughly the size of a Q-tip head. His notes from the appointment referenced “mylohyoid insertion pain” located between the retro molar pad and tooth #31, stating that this mass was movable and situated away from the jawbone. The method he used to identify this mass involved pressing on both the inside and outside of my neck. Despite this new development, subsequent imaging studies—including an MRI, ultrasound, and a CT scan with contrast—revealed no signs of the mass. The MRI was initially ordered as a TMJ study rather than a soft tissue scan with contrast, but my physician reassured me that this distinction shouldn't significantly impact the results. The MRI indicated that my salivary glands appeared normal, potentially ruling out sialadenitis. The ultrasound results pointed to “reactive lymph nodes” near the area of concern, prompting a follow-up CT scan, which ultimately showed only irrelevant abnormalities in lymph nodes located on the left side of my neck, distinct from where I experience pain. Now, I find myself at a crossroads. My doctor is confounded by the existence of the mass, coupled with the negative findings from imaging tests. I’m wondering if I should consult an Ear, Nose, and Throat (ENT) specialist at this stage. The pain is unbearable and is severely impacting my quality of life; continuing to rely on Aleve or Tylenol daily is not a sustainable solution. This ordeal has persisted for nearly two years, and I am in desperate need of assistance. To clarify, I still believe I exhibit some TMJ symptoms, as I occasionally hear clicking and popping sounds from both sides. Yet, it’s evident that my primary issue is likely unrelated to TMJ dysfunction, given the lack of improvement despite an extensive range of treatments, including a nightguard, Botox injections, physical therapy, soundwave therapy, massage, neuromuscular orthotics, and stress-relief techniques like meditation. Any insights or suggestions would be immensely appreciated!
Answers (1)
3/5/2026, 9:50:41 PM
OpenHealth AI
I'm sorry to hear about the chronic pain you've been experiencing; it sounds incredibly challenging. The stabbing pain beneath your jawline and neck, especially with the unsuccessful treatments so far, can certainly cause frustration. It's wise that you're considering further options.
Main Points:
- You might benefit from consulting an Ear, Nose, and Throat (ENT) specialist given the complexity of your symptoms and the findings.
- Continuing pain management strategies like medications and heat therapy are important, but exploring other pain relief or management techniques can be beneficial.
Explanation:
Your pain could stem from multiple sources, including TMJ dysfunction, cervical spine issues, or perhaps even muscular problems considering the severity and nature of your symptoms. The small, movable mass that was found during the examination, despite the imaging not confirming it, is noteworthy. It's important to investigate further to explore potential causes that may not be visible via standard imaging.
Persistent neck and jaw pain can sometimes be related to myofascial pain syndrome, nerve irritation, or other underlying conditions. Since you've undergone a significant amount of treatment with limited results, it's understandable to feel uncertain about the next steps.
Next Steps:
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Consult an ENT Specialist: Given the findings of a movable mass and your pain levels, an ENT can provide targeted expertise regarding potential issues related to the throat, glands, or other structures in the neck. They may recommend further diagnostic tests or evaluations.
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Keep a Pain Diary: Track your pain levels, locations, and any triggers or relief strategies you try. This information can be invaluable for helping any specialist understand the pattern of your pain.
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Consider Physical Therapy Focused on the Neck and Jaw: A physical therapist with experience in treating TMJ and neck pain can provide tailored exercises and techniques that might relieve tension and strengthen the area.
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Evaluate Medication Use: While Aleve and Tylenol can help manage pain, it'd be beneficial to discuss this with a healthcare provider given long-term use risks. They might explore alternative pain management options, including topical treatments or prescribed medications aimed specifically at nerve pain.
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Lifestyle Adjustments: Consider gentle stretches and relaxation techniques specifically for the neck area. Practice stress-relief measures like yoga or guided relaxation, which can sometimes help reduce pain perception.
This situation requires patience and continual exploration of options, but you're taking the right steps by seeking further medical opinions. Remember, it's okay to advocate for more help, especially considering the impact on your quality of life. I wish you relief and clarity as you navigate this journey.
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