Nerve pain and rheumatism

[MaryM]

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.

[Kevin Pho, MD]

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.

[kevinmd]

I'll be away until January 4th - I will answer your question when I return.

Happy holidays,
Kevin, M.D.

[Ed R.]

I am a 41yo male active and healthy who came down with an apparent stroke in my peroneal nerve last Sept.which resulted in a left foot drop and severe nerve damage on my left side with mild weakness right foot.   I went through all the nerve conduction tests,ivig treatments, mris, lumbar puncture and finally a nerve and muscle biopsy.  The neurologists are puzzeled by my case and were hoping the biopsy might show vasculitis, but the results where inconclusive.  I was then referred to a vasculitis clinic at JHopkins, he wants to place me on 60mg prednisone for 6-9 months even though there is no sure way to determine if vaculitis is active non-systemic.  I have been reading up on prednisone and cytoxin and it sounds like the worst treatment possible. I am fearful and need to make a decision soon.  Are there any other alternative treatments for vasculitis?  Thanks for hearing me. Ed in MD