advice please, what further tests should I try?

I live in the UK. Four years ago I developed painful burning feet when walking which then became buzzing as if I had electrical socks on.  I had mood swings and brain fog. I went to my GP who did a full blood test - all normal.After a while I fell ill in bed for several weeks with what was flu like as the buzzing spread all around my body and I had severe stabbing pains, constant muscle twitching anywhere in body and at any time, aching , stiff clicking joints especially ankles. Because the symptoms migrated all around my body my doc said it may be viral, also kept implying it was stress or depression - yet I had always been an active and positive person. I took months off  work to nuture myself and prove no stress involved.
I never got rid of the  strong tingling electrical buzz in feet and legs although other things seemed to improve but then for no reason would have a sudden bad flare up of the same symptoms, particularly prior to a period or if I caught a cold. My doc then said that it could no longer be considered  due to stress it could be MS. I had one MRI scan of brain and neck, no lesions found. (neuro report remarked I had very pale optic nerve) . I was discharged and no further tests done (did ask for repeat bloods but all normal) and my doctor says she doesnt know what it is and can only offer help with symptoms.
With this recent cold weather I have had another bad flare up, as with all of them worse from early evening til morning (aching hips neck and shoulders), but once I force myself up they become less noticable. I have weird crawling sensations in my skin or burning patches but these come and go also. The buzzing is also in my arms and lips. I do have  a bit of back ache
I want my doc to refer to a neurologist to explore further. In your opinion what should be considered, eg a spine scan? I have been trying to accept I have this 'thing' and make the best of things but am only 45 feeling more like 64!. Thank you

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

In general, migrating buzzing and shooting pains would be difficult to explain by a neurologic disorder, and some of the symptoms you describe above such as fogginess and clicking joints etc would be difficult to tie all these symptoms together due to a neurologic cause. Whether or not imaging of the spine is indicated depends on what the exact symptoms are and the examination as conducted by a neurologist.

Burning in the feet could be due to a neuropathy. A neuropathy is a generic term for some sort of dysfunction of the peripheral nerves. There are 2 types of nerves in our body, large and small. The small nerve endings supply the skin and sweat glands. There are two types of sensory neuropathy: small fiber and large fiber (depending on the size of the nerves affected). With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, autoimmune problems

The other type of neuropathy is called a large fiber neuropathy. There are several categories of this type of neuropathy, and there are many many causes. Sensory neuropathies can involve just one nerve or several nerves in the body. The symptoms are sensory loss and if motor nerves are involved, weakness. Some types of sensory neuropathies occur and progress very slowly, others sort of wax and wane (with flare-ups) and some are progressive. One of the most common causes of neuropathy is diabetes, and sometimes only glucose intolerances, or abnormal rises in blood sugar after a glucose load can be the only indication (this is called a oral glucose tolerance test. Other causes include but are not limited to hereditary/genetic causes, autoimmune problems, and demyelinating diseases (such as CIDP). Vitamin B12 and B6 deficiency, as well as excess vitamin B6, can also cause neuropathy. Some toxins, such as lead, arsenic, and thalium can cause large fiber sensory neuropathy. Other causes include abnormalities of protein metabolism. In many neuropathies, both the sensory and motor nerves (the nerves that supply the muscles) are involved, leading to sensory symptoms as well as weakness.

The diagnosis of large fiber neuropathy is made by findings on a test called EMG/NCS which assess how well the nerve conduct electricity and how well muscles respond. Rarely, in some cases a lumbar puncture provides useful in formation, and very rarely a nerve biopsy is required.

The same processes that affect large fibers can affect small fibers. For example, diabetes can typically do this.

Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well). These should be prescribed only after the diagnosis is confirmed.

Evaluation by a neurologist is a good idea; continued evaluation with your physicians is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.