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Fibromyalgia


  I am a 32 year old male in good fairly good physical condition. About six months ago I began having burning tingling sensations in both of my feet across the ball of my foot and arch. These symptoms would occur about once or twice a week. My Internist referred me to a Podiatrist who X-rayed my feet and said everything looked o.k. except my feet were quite flexible and pronated. She thought I might have a mortons neuroma and told me to take advil and wear orthotics. This seemed reasonable as I had just began to walk on my treadmill on a consistent basis.
  The pain went away for awhile and then returned a month or so later.My internist then referred me to a neurologist. He conducted a physical exam, EMG, nerve conduction test and a MRI of the brain and cervical spine. The neurologist told me everything looked normal and to come back in 6 months. Well the burning in my feet came back so I went back to the podiatrist who thought it was plantar faciitis. She prescribed physical therapy since the pain seemed to be in my arch toward the heel. The PT seemed to help.
  Then I began having sporadic tingling, burning sensations and soreness in my hands (palm, thumb and fingers, especially across back of knuckles). This would vary by day and by hand. Also both of my wrists and forearms hurt at least once a week. Some good days some not. Occassionally I would also have days of random twitching in my arms and legs.(Bad one day and then gone for a week.) I went back to my internest who ran a metabolic blood workup, ANA, and SLE test (no thyroid test). All came up normal except my cholesterol and triglycerides were high (runs in my family). He told me to come back in 6 months.
  Since the problem did not go away I went back to the neurologist. He said the wrist and hand paid wouldn't be carpal tunnel since my EMG and Nerve Conduction test were normal. He also said he did not think I had a neurological problem since I had no signs of nerve damage but thought I should go see a Rhumatologist for a Fibromyalgia evaluation.
  At this point I am not sure where to go. Do you think the hand and foot symptoms are related? Would Fibromyalgia make sense? I though that was mainly muscular leg and back pain and affected primarily women.
  Your advice would be greatly appreciated.
  Scott  
Dear Scott,
Fibromyalgia is a disorder that typically presents after a period of inactivity, a muscle of group of muscles become tender and painful.  The neck and sholders are the most frequent sites.  Sometimes firm tender zones can be palpated within the muscle.  Symptoms of fatigue, headache, insomnia and giddiness are sometimes associated.  Yes, it occurs more frequently in women, however, men can be affected. From what you are describing, it the diagnosis of fibromyalgia does not completely fit.  It sounds as if you have had a pretty extensive work-up.  One additional thought, A small fiber neuropathy/peripheral neuropathy could possibly explain the burning pain that you are experiencing in your hands and feet.  This may not show up on EMG exam. If not already completed, some additional blood work that may be helpful includes a sed rate, B12, folate,HBA1C, SPEP, TSH.  A nerve biopsy is also a suggestion.  Discuss these options with your doctor.  If ever you are interested in getting an evaluation at CCF call 1-800-CCF-CARE>  Good Luck.




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