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Neurology (Expert Forum)
Leg Pain
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Leg Pain
by Cathy Thornton, Aug 14, 1999 12:00AM
Hi Doc! For the past ten months, I have had pain on the inside of my left leg. It is only from the knee down and the left side of my foot also hurts. Initially, it only hurt when I was standing or walking. Now it hurts all the time, even at night. The pain is like a dull ache that is very deep. Sometimes it is a burning pain. I don't have any swelling or muscle weakness. I have been treated by several doctors, and taken lots of medicine but nothing has helped. I have taken anti - inflammatory medication that did nothing to help. I have been on neurontin, and it helped, but only for a couple of weeks. I am now taking palemor but it doesn't seem to be helping. I have had a nerve conduction test that was normal. I have had an mri of my back that was also normal. What should I do next? I am not making much progress with my neurologist.
Doctor's Answer
by CCF Neuro[P] MD, RPS, Aug 20, 1999 12:00AM
Dear Cathy:
With a normal MRI and nerve conduction study, it is difficult to tell you what you may have. Assuming that you have no systemic diseases, it is even more difficult to tell. However, what you describe seems pretty convincing that it involves a specific nerve distribution of L4. Since the nerve conduction study was normal it could only be small fiber pain. Some systemic diseases such as alcoholism or diabetes can cause small fiber loss. But one would have the history for these entities. Without being able to physical examine you, I am sort of at a loss. Maybe a second opinion might help. A fresh pair of eyes on the lab data, your medical history, and physical exam might uncover something. Sorry, I am not too helpful.
Sincerely,
CCF Neuro MD
With a normal MRI and nerve conduction study, it is difficult to tell you what you may have. Assuming that you have no systemic diseases, it is even more difficult to tell. However, what you describe seems pretty convincing that it involves a specific nerve distribution of L4. Since the nerve conduction study was normal it could only be small fiber pain. Some systemic diseases such as alcoholism or diabetes can cause small fiber loss. But one would have the history for these entities. Without being able to physical examine you, I am sort of at a loss. Maybe a second opinion might help. A fresh pair of eyes on the lab data, your medical history, and physical exam might uncover something. Sorry, I am not too helpful.
Sincerely,
CCF Neuro MD
CCF Neuro MD
The EMG does not pick up small nerve fiber conduction. Small fiber problems are usually due to systemic etiologies such as alcohol or diabetes or collagen vascular disease. However, there are many diseases and medications that can give you small fiber problems. Maybe a second opinion from another neurologist might help. Sorry, I can't help you much.
Sincerely,
CCF Neuro MD