Pain, numbness.. Should I see a doctor?

[frenetic88]

I have acute, sharp pains, usually in my limbs, nearly every day, with the location changing each time. It can last anywhere from a few seconds to a number of minutes, and is frequently quite painful. It usually feels like the pain is moving from the direction of my body, outwards towards my digits. It is also sometimes a dull throbbing, though this is less frequent.
My hands and feet are almost always very cold, unless the temperature of the room or outside is closer to my body temperature, such as 85F and up. Otherwise my hands easily become very cold, even when most others find it moderately warm.
Lately, I’ve begun to experience numbness and tingling in my hands, even when not doing anything but sitting.
Also, I’m not sure if this is part of the problem or not, but occasionally my hands will break out itching very badly for up to an hour or two, with seemingly no reason or correlation between events. When this happens, they typically begin turning dark red over much of my hand. Usually the itching is on my knuckles, between fingers, and my palms.
I don’t have high quality insurance, so I’m not wanting to run a bunch of unnecessary tests, if possible. So if anyone has any ideas on what this could be, It would be appreciated.

[Christopher R Newey, DO]

I would like to also add that a radiculopathy (pain from nerve root impingement either from bones or herniated disc) can cause shooting pains down an arm or leg. The pains are in a specific territory depending on the nerve affected. A radiculopathy is often diagnosed based on history, physical examination, and MRI of the spine.

[Christopher R Newey, DO]

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 a doctor.

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

I am not sure if you have ever sustained an injury to your extremities, back, etc, but one condition that can lead to some of the symptoms you describe is complex regional pain syndrome. Complex regional pain syndrome is a condition that is usually due to a soft tissue injury in many of the patients. Associated symptoms include abnormal skin color or temperature changes, abnormal sweating, and/or swelling of the affected extremity.  The exact pathophysiology is unclear. It is likely due to an abnormal reflex arc from the sympathetic nervous system modulated by cortical pain centers, e.g., brain, causing an increase in catecholamine hypersensitivity. This latter statement is important because the emotional disturbance caused by the injury in many patients may be a precipitating factor in the pain syndrome.  The treatment is multi-factorial and should begin with neuropathic treatment such as neurontin, lyrica, or elavil.

The numbness and tingling in your hands may be related to carpal tunnel syndrome esp. if the sensory changes do not involve the small finger. Carpal tunnel syndrome is a compression/entrapment syndrome of the median nerve at the wrist. It usually results from excessive use of hands and occupational “microtrauma”.  Other causes include hypothyroidism, amylodosis, and arthritis to name a few. It may also arise during pregnancy and resolve after delivery of the child. The sensory changes usually are worse at night. Patients may complain of having to shake their hand to wake it up. Over time, you may develop atrophy of muscles of the thumb supplied by the median nerve. This can be diagnosed by a neurologist with an EMG/NCS and clinical examination.

If your tingling and numbness also includes your feet and legs, I would advise you to be checked for diabetes. There are many other causes of neuropathic pain (that is the sharp pains and tingling sensation that you may be experiencing). These can range from vitamin deficiencies or toxicities to autoimmune disorders (such as Sjogrens or Lupus) to cancers, to name a few.

I understand that you are having insurance issues, but I do recommend that you be seen by your PCP for basic workup including a diabetes screen and other basic labs such as thyroid function panel and B12 level. You may need to follow up with a neurologist depending on your PCP’s findings.

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