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Chronic? Increasing pain throughout the body

  Dear Neurologists at MedHelp,
  First I would like to apologize for any typing or grammatical errors in this writing; English is not my native language. I must also confer with you that I am not very knowledgeable about English medical terms, so if I do not know a term I will try and describe what I mean. I'm afraid this is quite a long message, once again my apologies.
  I humbly though urgently request your attention for the pain my partner in life is and has been suffering for the past four to five years, with a dramatic increase over the past four months.
  I will describe her current situation first, followed with a short overview of the history leading to her current state of being.
  My partner is a fifty year old female, about 1.60 meters in height and weights about 42 kilograms. She does smoke. She is very kind and open to everyone, always has been ready to lend a helping hand and a listening ear no matter what. She is capable of extreme compassion, completely disregarding her own well-being.
  She is currently suffering extreme, unbearable pain throughout her entire body. Even wearing clothes is a constant battle. The sensations she is feeling are best described as follows:
  Constant pain with a burning and occasionally shooting sensation in her feet, legs, her pelvis and the area around it, lower and upper back, breast, neck, shoulders and arms. The soles of her feet and the skin on her head are so sensitive, that the lightest touch causes her pain. The pain in her feet and legs make it almost impossible for her to walk.
  She also suffers a similar burning pain all over her head and in her mouth. The pain in her mouth has become so unbearable that she can hardly eat anymore! Her tongue also has these pain sensations and shows cleaves (cracks) of various sizes, one bigger one in the middle and along the length of her tongue and numerous small ones on the sides. Her face, teeth and jaws also ache tremendously.
  Almost all her muscles feel very hard and are all cramped up. The muscles in her legs and bottom feel as if they are constantly being torn apart or stretched from her feet all the way to her lower back. The muscles in her neck and shoulder give her the same feeling, starting between her shoulder blades and moving up to her entire head.
  She recently visited a podologist? (the Dutch word is podoloog = feet specialist) who told her she was the most extreme case of cramped-up muscles she had ever seen and also told her that her central nervous system had gone in some sort of overload status, which is causing her muscles to tens up and relax continuously. By the way, nothing was found wrong with her feet.
  The dramatic increase in pain was, in our and the podologists opinions, caused by the therapy she received from a foot reflexzone therapist. She received twelve treatments, with each causing an increase in pain levels. Yes, we should have stopped earlier, but we were told that an increase in pain was to be expected, followed by a lessening of the pain. She had these treatments from June till October 1998. However since we stopped these treatments, the increase in pain did not stop and is still continuing.
  The first sensation of pain started some five years ago in her lower back, during a holiday with her sister in Spain. This pain was thought to be caused by her lifting and carrying heavy luggage. Over the years this pain expanded into her pelvis region and also started between her shoulder blades. She had short periods of lots of pain, alternated with (very) long periods of less and bearable pain. The burning pain sensation in her sitting bones and pelvis disappeared when she stood up and kept standing or walking. Up until the reflexzone treatments she was able to walk for long periods of time, do the shopping and light housekeeping etc. During that period she only had times of severe pain when she had overexerted herself, but this pain usually disappeared within a couple of days.
  Various examinations, including emg, x-rays, blood testing had no results other than that her ovaries are hardly producing any estrogen hormone anymore. She also had an MRI of the lower and upper parts of her spine revealing nothing wrong. Previous examinations have shown, that she suffers from arthrosis and osteoporosis.
  She has had all sorts of pain medicine ranging from paracetamol through various nsaids to morphine and Durogesic (fentanyl). Apart from the Durogesic none of these medications alleviated (some of) her pain. During the treatment with Durogesic on the first increase to 50 microgram/hour dosage she had considerably less pain for about 18 hours after that even an increase to 75 micrograms/hour had no effect.
  She also attempted T.E.N.S therapy, but this increased the pain.
  Her current medication consists of 2.5 mg of valium (Diazepam) twice daily and 20 mg Normison (temazepam) at night. The Normison allows her to sleep for approximately 2 hours. Up until recently she had a short time (a few minutes) relieve of her pain just after she woke up, but this is no longer the case.
  Her family doctor is now at a complete loss and thinks (claims) it is psychological. Now I can believe that some of her pain is psychological, but certainly not all!
  We seek your advice on what can still be done to diagnose her pain and/or alleviate it. Also any other thoughts you might have concerning her case are greatly appreciated!
  Many grateful thanks in advance for your time and knowledge,
  Marguerite and Roel, The Netherlands.
  Our email account is: rlange at worldonline.nl
This is very complicated. Clearly, no one else has answered yet and I think it's because it is difficult to figure out.
I am unaware of any single neurologic lesion which would cause pain in the distribution you reported. Your partner has been through quite a bit of testing designed to reveal problems in the brain and spinal cord. Common sources of pain such as "pinched nerves" have been ruled out.
Interesting - you mentioned her tongue. Has anyone checked into vitamin B12 deficiency? A long shot, but it doesn't hurt to try it.
Generally, when patients come to me with chronic pain, I suggest tricyclics such as imipramine or nortriptyline. These are the older antidepressants but they work very nicely for many kinds of pain in doses much lower than one would use for treatment of depression. The consensus opinion among neurologists is that the mechanism by which these agents act is different than the anti-depressant action.
When patients don't have adequate pain relief with my simple measures, I refer them to pain management specialists. I don't know if that is an option in the Netherlands, but you might look into it.
I wish I could be of more help. Good luck. CCF MD mdf.

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