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Arthritis (Expert Forum)
Nerve pain and rheumatism
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
Nerve pain and rheumatism
by MaryM, Dec 26, 2003 12:00AM
I’m writing on behalf of my 79 yr old mother. She has always been in very good health. Six months ago, she had developed sudden excruciating shooting pains in her left leg going from the hip to the knee. After 2 MRIs, a blood test and an EMG, all which have all proven negative, her Neurologist has been unable to fully diagnose the problem. The Neurologist is ‘assuming’ it’s being caused by a virus and will ‘get better’ although she has shown no significant improvement over the last few months. Currently she is on 3600/mg of Neurontin per day, and although it has relieved some of the sharp pains, she still has extreme discomfort with pins and needles and burning in the upper left leg as well as upper right leg and still has difficulty walking. Recently, I spoke to someone who has gone through a similar situation and had similar symptoms. She had seen a Rheumatologist who prescribed an antibiotic which had helped her pain. Could the nerve pain like my mother is experiencing have any thing to do with rheumatism and would it be worth her time to see a Rheumatologist? Any suggestions would be greatly appreciated as she is very desperate to be relieved of the pain.
Doctor's Answer
by Kevin Pho, MD, Jan 03, 2004 12:00AM
, Jan 03, 2004 12:00AM
Hello - thanks for your patience.
Radiating pain is suggestive of a nerve, or neuropathic type pain. The neurologist has already performed comprehensive testing including EMG and MRIs. She is already on a strong dose of neurontin, which is used to help neuropathic pain.
With the blood test, make sure the following has been tested: complete blood count, erythrocyte sedimentation rate (ESR), thyroid stimulating hormone (TSH), serum protein electrophoresis (SPEP), blood glucose, vitamin B12 concentration, antinuclear antibody, and urinalysis.
Other tests for nerve pain would be a nerve biopsy - which can be considered by the neurologist.
The only infection that I am aware of that can lead to such pain would be herpes zoster. Make sure that this has been considered.
If the neurology workup continues to be negative, you may want to consider a rheumatology referral - although I think that that avenue may be of low yield. A referral to a pain clinic or physiatrist can be considered to help manage the discomfort.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Radiating pain is suggestive of a nerve, or neuropathic type pain. The neurologist has already performed comprehensive testing including EMG and MRIs. She is already on a strong dose of neurontin, which is used to help neuropathic pain.
With the blood test, make sure the following has been tested: complete blood count, erythrocyte sedimentation rate (ESR), thyroid stimulating hormone (TSH), serum protein electrophoresis (SPEP), blood glucose, vitamin B12 concentration, antinuclear antibody, and urinalysis.
Other tests for nerve pain would be a nerve biopsy - which can be considered by the neurologist.
The only infection that I am aware of that can lead to such pain would be herpes zoster. Make sure that this has been considered.
If the neurology workup continues to be negative, you may want to consider a rheumatology referral - although I think that that avenue may be of low yield. A referral to a pain clinic or physiatrist can be considered to help manage the discomfort.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Happy holidays,
Kevin, M.D.