Pain and shivering upon touch in the upper body, including the chest, abdomen, and back, accompanied by sensations similar to fever and chills?
Hello Doctor: I am currently studying abroad, and I am having difficulty accessing medical resources.
I hope to receive some help through this message.
For the past year or two, I have been experiencing abnormal discomfort when my skin is touched.
I am not sure if I should describe it as pain; it feels similar to the chills one experiences with a cold or fever, and I am very sensitive to being touched by others or cold objects, which makes me want to shiver.
There are no visible abnormalities on my skin, and my temperature is within the normal range (usually slightly higher than average).
Additional information: The discomfort is particularly severe when I am fatigued or exhausted.
I often feel tired and weak.
I have a history of gastrointestinal issues, including duodenal ulcers, gastric erosions, and gastroesophageal reflux disease (GERD), and I am currently not on medication.
I also experience mild sleep disturbances and occasionally take sleep aids to help me sleep.
My work involves extensive computer use, requiring me to sit for long periods, which often leads to poor blood circulation and cold extremities.
Typically, the discomfort lasts for several days, and light exercise provides slight relief, but it quickly returns.
I would like to ask the doctor what might be causing this condition.
Could it be due to inflammation in some part of my body, or could there be other reasons? It is genuinely uncomfortable and affects my daily life.
I am currently unable to return to Taiwan for medical treatment and am unsure which specialty to consult.
I hope the doctor can assist me.
A-Heng, 20~29 year old female. Ask Date: 2018/01/04
Dr. Jiang Junyi reply Neurology
Hello: Your symptoms are more indicative of neuropathic pain, which is typically caused by damage or disease affecting the somatosensory nervous system.
It particularly resembles peripheral nervous system disorders, commonly seen in postherpetic neuralgia, but can also arise from central nervous system conditions such as traumatic brain injury, spinal cord injury, and multiple sclerosis.
This type of abnormal pain (pain in response to normally non-painful stimuli) and heightened pain sensitivity (increased response to painful stimuli) are two primary symptoms of neuropathic pain.
Since sensory abnormalities are subjective experiences, they can be easily influenced by psychological factors and personal past experiences, making them difficult to detect through objective examinations.
However, surveys of patients with neuropathic pain have shown that 18% report allodynia (pain from light touch), 14% experience paroxysmal pain from cold or heat, and 47% of patients with postherpetic neuralgia report tactile-evoked abnormal pain.
Current treatments for neuropathic pain primarily target the underlying causes, with certain medications showing significant efficacy for postherpetic neuralgia.
While abroad, you may consider supplementing with B vitamins and remind yourself to get up every half hour to perform stretching exercises to avoid nerve compression and muscle tension that could exacerbate your symptoms.
I recommend discussing further evaluation and treatment options with a neurologist.
Wishing you good health and peace.
Dr.
Tao, Neurology, cares about you.
Reply Date: 2018/01/04
More Info
Your symptoms of abnormal skin sensitivity and discomfort upon touch, particularly when feeling fatigued or under stress, may indeed suggest a neurological component. This condition, often referred to as allodynia, occurs when a stimulus that does not normally provoke pain (like light touch) causes pain. This can be linked to various underlying neurological issues, including peripheral neuropathy, central sensitization, or even psychological factors such as anxiety and stress.
Possible Neurological Causes
1. Peripheral Neuropathy: This condition involves damage to the peripheral nerves, which can lead to abnormal sensations, including pain and sensitivity. It can be caused by various factors, including diabetes, vitamin deficiencies (especially B vitamins), and certain medications. Given your history of gastrointestinal issues, malabsorption could also contribute to nutrient deficiencies.
2. Central Sensitization: This is a condition where the central nervous system becomes sensitized to stimuli, leading to heightened pain responses. It can occur after an injury or in chronic pain conditions. Stress and fatigue can exacerbate this sensitivity, making you more prone to discomfort from normal stimuli.
3. Psychological Factors: Anxiety and stress can significantly affect how we perceive pain. Your mention of feeling fatigued and having sleep disturbances could indicate that your body is under stress, which can amplify pain sensations.
4. Inflammation: While you mentioned that you do not have visible skin abnormalities, underlying inflammation in the body can still lead to heightened sensitivity. Conditions like fibromyalgia, which is characterized by widespread pain and sensitivity, could also be a consideration.
Recommendations
1. Consult a Neurologist: Since your symptoms are suggestive of a neurological issue, it would be beneficial to consult a neurologist. They can perform a thorough examination and possibly recommend tests such as nerve conduction studies or imaging to rule out any underlying conditions.
2. Manage Stress and Fatigue: Since you noted that your symptoms worsen with fatigue, it’s essential to prioritize rest and stress management. Techniques such as mindfulness, meditation, or gentle yoga can help reduce stress levels.
3. Physical Activity: Engaging in regular, moderate exercise can improve blood circulation and may help alleviate some of your symptoms. However, ensure that you do not overexert yourself, as this could lead to increased fatigue.
4. Nutritional Support: Given your gastrointestinal issues, consider consulting a nutritionist to ensure you are getting adequate nutrients, particularly B vitamins, which are crucial for nerve health.
5. Ergonomic Adjustments: Since you spend long hours at a computer, ensure that your workspace is ergonomically designed to reduce strain on your body. Take regular breaks to stretch and move around to improve circulation.
6. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing and managing your condition.
Conclusion
Your experience of abnormal skin sensitivity and discomfort is complex and multifactorial. While it may be rooted in neurological issues, factors such as stress, fatigue, and nutritional status also play significant roles. Seeking professional medical advice is crucial, especially since you are currently abroad and may have limited access to healthcare resources. By addressing both the physical and psychological aspects of your symptoms, you can work towards finding relief and improving your quality of life.
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