I have twitchy, sharp, and achy pain all over my body for eight months. How to manage it?

Question

Hi doctor,

For the past eight months, I have had these intermittent symptoms throughout the day. I do get a warm type of feeling, like warm water flowing through my body. Every day it affects different parts.

There will be a pain in the forearms, not muscular, but sometimes twitch. In the biceps, it will be a strange sensation, twitching, and fatigue. In fingers, there will be electrical pain. Arms feel weak, but I have full strength. In my shoulder, I have pain in the deltoid region. There is numbness on the outer side of the thigh, sharp, achy pain and feeling of pressure, and twitches. Tingling and numb sensation in the knee. Achy pain towards the back, down, and sides of the legs. Twitching and tingling sensation in the feet, achy pain in the butt, and pressure pain in the tailbone.

EMG and NCS were done on the right side. The neurologist said it was consistent with neuropathy and that I had idiopathic progressive neuropathy. I want a second opinion. Blood work (out of range), did three ESR in the last eight months-36 mm/hr, 41 mm/hr, 32 mm/hr, IgG-1658 mg/dL, LDL-121 mg/dL, non-HDL-139 mg/dL, and an MRI of the brain. Currently, I am taking Gabapentin.

I am frustrated because of this. What should my next step be? My father has multiple sclerosis, so should I try to get an MRI of the spine? Please help. Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I would like to know some further details about your symptoms.

As mentioned, your symptoms are intermittent, but how long do they persist in one go?
Do you also have associated fast heartbeat or feeling of impending doom or shallow breathing during your mentioned symptoms?
Were you able to notice in which all situations your symptoms get triggered or worsened?
Were the symptoms the same from the beginning or progressing or regressing with time?
If symptoms are progressing, please tell your initial symptoms and how they sequentially increased with time.
Any other significant past medical history or some long-term medication?
In what dose are you taking gabapentin? And did you get some symptomatic relief on taking it?
Did you have intermittent fever, cough, or weight loss in these eight months?
Do you have any neck or back pain?
Do you have any joint pain (small joints or large joints), photosensitivity in sunlight, and recurrent mouth ulcers?
How is your sleep routine? Do you get sleepy soon after lying in bed, or does it take a long time? Do you have frequent awakenings during sleep? After getting up, do you feel fresh in the morning?
How is your usual mood in day-to-day activities? Happy or sad (thinking about past events), or worried (thinking about future), or irritable?
How is your appetite?

Please do the following investigations.

MRI (magnetic resonance imaging) of the whole spine, serum vitamin D3, serum vitamin B12, T3 (triiodothyronine), T4 (tetraiodothyronine), TSH (thyroid-stimulating hormone), ANA (antinuclear antibody)-IFA (indirect immunofluorescence assay) method, ENA (extractable nuclear antigen) profile, and dsDNA (double-stranded deoxyribonucleic acid). If neuropathy is confirmed, then its cause and treatment need to be found out. Please attach your NCV, nerve biopsy, and other blood reports and revert so that we can proceed with further evaluation.

Answer 2

Hi,

Welcome back to icliniq.com.

As per your description of symptoms and reports (attachments removed to protect the patient's identity), your NCV (nerve conduction velocity) shows only mild impairment in few nerves. Also, you did not get relief in the symptoms by Gabapentin 600 mg, which is a fair dose. The possibilities can be,

1. Anxiety-induced somatic symptoms.

2. Fibromyalgia.

But before that, other causes also need to be ruled out. I recommed you do an MRI of the whole spine, serum vitamin D3, heavy metal screening, ENA profile, bone mineral density test, serum calcium (ionic) level, serum parathormone 1 level. Also, attach the nerve biopsy report.

My differential diagnosis would be,

Anxiety induced somatic symptoms.
Fibromyalgia.

I suggest you consult a psychiatrist for controlling the associated anxiety. Maybe after reducing the stress, symptoms may get better.

Also, try to do some modifications in lifestyle like,

Daily jogging for twenty to thirty minutes in the morning.
Maintain regularity in sleep, wake, and meal timings.
Try meditation and yoga. Please revert with the reports.

Answer 3

Hello,

Welcome back to icliniq.com.

The biopsy you underwent is primarily skin punch biopsy (not directly nerve biopsy). And they have checked epidermal (skin) nerve fiber density in that, which they found less. And they did not find any small vessel vasculitis in that skin punch biopsy. But it's not a direct nerve biopsy. I feel this finding is not a diagnostic method for neuropathy. Also, your symptoms are not fully explained by neuropathy.

Thank you.