Looking for advice on chronic pain in the right side of my body (right arm in particular)

Hi all,

I hope somebody on here has some advice for me on these problems, because I'm at my wit's end.

First, here's my story (I'll try to keep it short). In May 2007 (in an emotionally turbulent time for me) a chronic pain developed quite suddenly in my right arm, all the way from my shoulder to my fingertips). In the years before I had had some periods of mild RSI and back pains, but this was of a completely different order. After almost 3 years of struggling with this and doing fitness and various exercises to no effect, a chronic pain developed in my right leg (again quite suddenly and in a very stressful period). It was triggered during a race at long distance running (I'd been running for about 45 minutes). Since then the pain in my leg has slowly been getting worse, just like the pain in my arm. I have some pain in my back and right side of my torso as well, and in the last couple of weeks I seem to be developing a chronic pain in the right side of head (mostly in the jaw). I think I grind my teeth in my sleep too. Lately I've also noticed that my right pupil is constantly quite a bit larger than my left pupil (I think this might be connected to my other problems because of this post: http://*****************/question/index?qid=20110116192706AANmnhU).

I've been to various doctors and have had some scans and strength tests (on which nothing abnormal has been found). I'm  going to the gym twice a week to do various exercises, and I'm going to a psychomotor therapist once every few weeks. So far, all this medical help has not relieved the pain at all. The only thing that really seems to help is to keep moving; however I'd like to sit down sometimes and I have to sleep, and then the pain comes back quickly. I take amitryptiline as a painkiller to very little effect.

I've recently asked for an appointment with a neurologist, which is now scheduled at the end of June (apparently the earliest they could do).

I personally think stress and chronic overstraining of muscles could very well be causes of my problems, so I try to avoid those two factors as much as possible. I try to spend as little time at the computer as possible, I make sure I get enough sleep, eat well, and stay fit and healthy in general. So far all this has not led to any significant improvement. Lately I've been starting to pay more attention to possible neurological causes, and the development of pain in the right side of my head, and the large right pupil seem to me to confirm that maybe some muscles are pressing into some nerves.

Anyway, I hope my story and the symptoms ring a bell with some people, and any advice on what I could do (in regards to therapeutical methods, medicine, food, exercises, etc.) to alleviate this pain is greatly appreciated! It's only been getting worse for 4 years now, it's time to change that around.

Regards,

David

[Dr Sharma]

Hi there. I went through your symptoms and empathize with you. I would think of two conditions from your symptoms. These multiple neurological symptoms including right arm and leg pain, large right eye pupil and right sided headaches could be due to a chronic demyelinating condition called multiple sclerosis where the disease phase is characterized by active phase and remissions. It has multiple symptoms and signs and is a diagnosis of exclusion. The symptoms of multiple sclerosis are loss of balance, muscle spasms, numbness in any area, problems with walking and coordination, tremors in one or more arms and legs. Bowel and bladder symptoms include frequency of micturition, urine leakage, eye symptoms like double vision uncontrollable rapid eye movements, facial pain, painful muscle spasms, tingling, burning in arms or legs, depression, dizziness, hearing loss, fatigue etc. You have many of these symptoms. The treatment is essentially limited to symptomatic therapy so the course of action would not change much whether MS has been diagnosed or not. Apart from clinical neurological examination, MRI shows MS as paler areas of demyelination, two different episodes of demyelination separated by one month in at least two different brain locations. Spinal tap is done and CSF electrophoresis reveals oligoclonal bands suggestive of immune activity, which is suggestive but not diagnostic of MS. Demyelinating neurons, transmit nerve signals slower than non-demyelinated ones and can be detected with EP tests. These are visual evoked potentials, brain stem auditory evoked response, and somatosensory evoked potential. Slower nerve responses in any one of these is not confirmatory of MS but can be used to complement diagnosis along with a neurological examination, medical history and an MRI and a spinal tap. The other possibility is of CRPS 1 or reflex sympathetic dystrophy due to an injury or insult. Pain comes on by itself and is easily provoked and much more severe than anticipated. There could be other accompaniments like edema skin blood flow changes and abnormal sweating. Therefore, it would be prudent to consult your neurologist with these concerns. Take care.