Intermittent bilateral leg pain

[edw1]

Hi there,

I'm a first year medical student and I'm asking this question on behalf of a friend of mine whom I've been trying to help for several years. T. has been having intermittent episodes of severe (10/10) bilateral calf pain at rest. She describes it mostly as "awful pressure, pulling, and squeezing," in her calves. NSAIDs and tramadol don't touch it at all, but the pain is responsive to stronger opiates, and seems to significantly diminish when she takes a hot bath. It usually lasts several days at a time, though sometimes it's bad for weeks on end. It tends to show up at random, and go away at random. There are no neurological deficits, and an MRI of her lumbar spine was all clear.

No one can seem to figure out what's causing the pain -- things that have been ruled out include fibromyalgia and restless leg syndrome -- so I've tried doing a bit of research to see if I can help. I've lately been wondering if it could be something related to her microvasculature, like a peripheral version of cardiac syndrome X. I asked her to talk to her family doctor about trying a vasodilator to see if that would help, but he doesn't buy it; he just gives her a shot of demerol when she comes in and tells her to go home. This seems like a really poor way of managing the pain, especially when it returns a few hours later.

Any ideas for what might be causing this or how to get it properly diagnosed? It's really taken a toll on her quality of life and no one seems to be motivated enough to investigate it.

Regards,

Ed

[sofa weight]

I don't know what is wrong with your friends legs. However, I do have a similar thing going on, but it is only in one leg. I have been having nerve pains and joint pains for about 8 years and after many years of seeing the standard set of doctors for the regular 2 minute appointments that resolved nothing and the standard 3 month 2 minute follow ups, my really excellent PCP sent me to the cleveland clinic and I was diagnosed on the first day with ehlers danlos. I am not saying that your friend has EDS. I'm just giving some background.
Next, I'll get to the point.
I have had for the past 2 years, really bad pain down my left leg and a feeling of my butt and legs being submerged in an ice bath. I have also had severe cramps most of the time in my left calf muscles that wake me up at night.
In order to get through the night without being awaked by the spasms, my PCP prescribed zanaflex for me to take before going to bed. That helped a lot. However, I only take it at night and it doesn't last for very long.
I have a pain management doctor that I ahve been seeing for a couple of years and although my many spine MRIs have only shown slight bulges and degeneration in the facet joints and my EMGs have been normal in that leg aside from amplitudes double that of the other leg, my pain management doctor uses a nerve scan rather than an emg. the nerve scan is like an emg, except it is sensory in that it runs a little bit of current at various places that is slowly increased until you can feel it. Using that scan, she is able to tell where the problem is. For instance, the position for S2 on that scan (which would be my calf muscles) was off that chart meaning that they turned it all the way up to where it should be super crazy painful and I coudln't feel a thing. That means that there is something wrong with the afferent fibers there. Knowing how feedback works and how the dorsal root ganglion does the wind up based upon feedback, it could explain why i have the spasms there. a few weeks ago when I was having crazy bad spasms in that leg, she did some injection around S2 (I have no idea what she injected because she never tells me), but it totally stopped the spasms for a whole day and then after that the spasms were very much reduced. They returned after a few days, but the point is..
normal mri and normal emg doesn't mean there is nothing wrong. emg tests large fibers and mostly motor.
My non medical and non professional suggestions are these.. bloodwork for metabolic panel and vitamins. if those are normal, then perhaps a pain management doctor who will run a nerve scan and see what shows up there. Also, because the area between the spine and legs is the pelvis region and because lots of things in there can cause nerve compression or compression of arteries or veins, an mri of the pelvis would be a good idea.
Then again, I'm not a doctor. But I have been going through a similar thing for many years. :)

[Dianegi1]

A related discussion, bilateral leg pain and feeling to stretch legs was started.

[ashleyhicks13]

I have been having bilateral leg pain for about 20 years that starts right above my knees and goes to my feet or ankles. When I was young my mom who is rn chalked it up as growing pains, then I was big into sports so that was the excuse, after college im still having problems and started seeing several doctors, did work ups for rhematoid arthritis, and had mri, sleep study, ct scans etc found nothing wrong...last doc said its either fibromyalgia or restless leg syndrome but I believe she was giving up. Pain only at evening and no pain meds alleviate pain, hot bath takes pain away until I get out of the bath, it comes right back, next morning the pain is gone ...my mother has syringomyelia and arnold chiari, I was tested for both but nothing, aunt has ms....im clueless as to what to do or what specialist to see...help!!!! Im 26 and have been dealing with this in spurts several months here then couple of months relief. But pain is so debilitating feels like someone is just sqeazing my lower limb bones....I don't know
..any help would be appreciated

[ashleyhicks13]

Hhh

[ally2]

Venous insufficiency.  I have been looking on the web a lot, I have pain in both my legs and upper arms. I have it in my thighs.  I have not found what is wrong with me, but   I found a lot of information on calf pain.  This cause pain only at rest, not when walking.  Since you are a first year medical , do you know what may be wrong with me.  I also have shortness of breath(mild)  I am thin, eat well and have not know heath issues. Thanks!

[docgaurav]

I am a pediatrician and my wife is an ophthalmologist. She is suffering from severe calf pain, causing her to cry to sleep almost every night for weeks. Calcium, Vit E, Levocarnitine, Co Q, Riboflavine have not shown any benefits. Tizanidine has a limited effect.
Please let me know as to what further steps can be taken? The physicians have not been able to diagnose anything.

[J T Junig, MD PhD]

You are correct in your opinion of the 'treatment' your friend is getting.  The actions of her doc are an extreme version of the problems with modern medicine;  it is as if the doc is just trying to get the patient to leave, no matter what it takes.  

I'm not hitting anything out of the park tonight.  If something comes to mind I will be back;  in the meantime, if anyone else has an idea, please let us know.