Question about diagnosis

I am a 48 year old female. Two years ago I developed sciatica-like pain on the left. Straight leg raising test was always normal. MRI showed no disc or bony lesions but showed swelling of nerve roots. Multiple blood tests and LP were normal. Pain became more severe. On four occasions severe pain across top of thigh made walking impossible. Then began to develop pain in both arms and eventually left leg also. Further investigations. Only abnormality was bone scan showing "hot spots" in both shoulders, both hips and right knee.

Get occasional pins and needles in legs, feet and hands. Movement of joints is beginning to get painful, but no swelling or redness. (Have always had very good joint mobility and flexibility)

Have been diagnosed with Fibromyalgia. Am in almost constant pain, despite analgesics and antiflammatories. Major problem with sleep. Wake up in pain regularly. Have become increasingly disabled and now my career is in jeopardy.

The pains I have were always difficult to track when they started in each limb, but in the last 6 months it has become clear that they are following nerve root patterns in all limbs. My questions:
(a) is this type of pain typical of fibromyalgia?
(b) given the MRI finding of inflammed nerve roots without any obvious cause and the bone scan findings of "hot spots" should I accept the diagnosis of fibromyalgia or look for further investigations.
Any advice welcome as I am getting a bit desperate about the future.
Thank you

[Kevin Pho, MD]

To answer your questions:
1) Fibromyalgia can possibly explain the symptoms.  Before attributing it to this disease, you may want to exclude other disorders - such as peripheral neuropathy and other neuropathic diseases.  ANA levels and a rheumatoid factor can be drawn to exclude other rheumatologic disease.

2) Other than the aforementioned tests, you can consider electrodiagnostic testing, such as an EMG, to rule out neuropathy.  

A referral to a neurologist or rheumatologist can be considered to further evaluate the symptoms.

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.

Kevin, M.D.
kevinmd_