Widespread Pain: When to See a Specialist for Neurological Issues - Neurology

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Multiple areas of pain in a short period of time?


Over the past month, I have been experiencing various pains throughout my body.
Initially, I consulted a specialist, but due to the wide range of symptoms and the duration of the issue, I began to wonder if it might be related to nerve or blood problems.
I am preparing to see a doctor but am uncertain about which specialty to consult, as I am not sure if these issues are isolated or indicative of a systemic problem.
I will explain my situation in detail, and I apologize in advance for the length of my message.
First, my medical history: I have experienced chest tightness, pain, and shortness of breath since childhood.
In my teens, I visited a cardiologist due to frequent heart pain, and I was diagnosed with mild thalassemia.
Over time, I became less concerned about the heart pain, as it seemed to improve in frequency, except during intense exercise when I would feel short of breath and nauseous.
I also experience leg numbness after squatting for a short time.
Due to my anemia, my menstrual cycle has been irregular, sometimes delayed by up to three months.
When it gets severe, I take traditional Chinese medicine (like Si Wu Tang), which usually helps restore my cycle the next day.
In the past month or two, I have not had my period for about four months.
I have tried Si Wu Tang and other herbal remedies without success.
I initially planned to consult a traditional Chinese medicine practitioner for treatment, but I began experiencing pain in multiple areas of my body, which made me hesitant about whether to see a traditional Chinese medicine doctor or a Western doctor, fearing that a traditional practitioner might not detect underlying issues.
The pain began with my right knee, which hurt at night, especially when pressing on the joint.
A few days later, my left knee started to hurt as well.
Simultaneously, I began experiencing abdominal pain at night, which lasted for several days but was not constant.
The pain varied in location: sometimes in the upper abdomen, sometimes in the left upper quadrant, and at times in the right lower quadrant.
I even suspected it might be related to my uterus due to the daily pain.
I first consulted a gastroenterologist, who suggested that I had a buildup of fecal matter.
Although I was regularly having bowel movements, after taking medication, I found that I was going less frequently.
Once I finished the medication, the daily pain subsided, and I felt relieved, but I still experienced intermittent pain, particularly in the right lower abdomen, and occasional pain in the area just below my chest.
After the knee pain, I began to experience pain in my right elbow, which led me to believe there might be an internal issue.
I decided to see an orthopedic specialist, initially thinking there would be no problems.
After the orthopedic consultation, I planned to visit a hematologist or rheumatologist.
However, the doctor informed me that my knee showed significant wear, with the right knee being worse than the left.
I was advised to take medication and undergo rehabilitation.
The doctor found no issues with my elbow, attributing the pain to tendon problems, and I was given topical medication.
After completing the knee medication, the pain became less frequent, and I thought my condition had improved.
Recently, however, I have been experiencing an increasing number of issues.
I had sudden pain in the outer side of my right thigh multiple times.
I had previously had a pencil lead embedded there, but it had been a long time, and a dermatologist had previously assured me it was not a concern.
I wondered if this was now causing problems, but shortly after, I experienced similar pain in the outer side of my left thigh.
The pain typically lasted only a few minutes.
I also experienced sudden pain in my left shoulder and back, as well as in the groin area.
I often felt as if I had strained my muscles, starting with my knees, then my thighs, and now my ankles, which felt like they were frequently twisting.
However, these sensations would usually resolve themselves within a day or two.
I also experienced sudden joint pain in my feet and fingers, which would subside after a few minutes.
Recently, I have had more intense and sudden pain in my calves, which has been difficult to tolerate, and I have been using muscle relaxants for relief.
A few days ago, while brushing my teeth and bending slightly, I suddenly felt significant pain in my lower back, but when I bent fully, the pain disappeared.
Six months ago, I had an X-ray for tailbone pain, which showed normal results, with only soft tissue injury noted.
The doctor said it would heal in one to two months, but I still experience pain after prolonged sitting, although it has improved significantly.
I am unsure why this pain has suddenly intensified.
Additionally, two days ago, I experienced sudden and severe pain in the inner side of my left wrist (near the veins), which lasted several minutes and required rubbing to alleviate.
I have also been experiencing frequent heart pain, sometimes accompanied by pain in the right side of my chest and a feeling of shortness of breath.
I would like to ask:
1.
Could these symptoms indicate poor blood circulation or insufficient blood supply? I have previously experienced similar symptoms related to inadequate blood flow to the heart.
Could this recent severity be causing these issues? If so, would seeing a traditional Chinese medicine practitioner be sufficient?
2.
Given the widespread nature of the pain, could it be a nerve issue?
3.
Since the pain is widespread, I feel it is not isolated to one area.
I have seen specialists for my knee and gastrointestinal issues, but while they provided some relief, they did not resolve the underlying problems.
Are the issues with my knee and gastrointestinal system separate, or could they be interconnected?
4.
Based on my symptoms, can you provide any preliminary insights into what might be happening with my health? I would like to be mentally prepared.
5.
I have previously consulted a cardiologist for heart-related issues, but my heart has been cleared of problems, and my orthopedic X-ray results were normal.
Given my current symptoms, which specialty should I consult next?

Niming, 20~29 year old female. Ask Date: 2021/03/18

Dr. Jiang Junyi reply Neurology


Hello: It is recommended that you print out the detailed description and discuss it with your physician.
Based on your description, fibromyalgia should be considered.
Clinically, it is differentiated from other conditions that present with widespread pain, such as inflammatory or degenerative arthritis, thyroid disorders, vitamin D deficiency, systemic lupus erythematosus, polymyositis, liver disease, kidney disease, leukemia, hypercalcemia or hypocalcemia, hyperkalemia or hypokalemia, infections, etc.
There is no specific test to definitively diagnose this condition; if blood tests or diagnostic imaging show abnormalities that suggest other diseases, the possibility of fibromyalgia cannot be ruled out, as both conditions may coexist.
According to the 1990 criteria set by the American College of Rheumatology, the pain must involve both sides of the body and the upper and lower parts of the back, persisting for more than three months.
Chronic widespread pain, combined with tenderness at more than 11 of the 18 specific tender points on the body, can lead to a diagnosis of fibromyalgia.
Currently, rheumatology and neurology departments are more familiar with such conditions.
Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Hospital, cares for you.

Reply Date: 2021/03/18

More Info


Understanding widespread pain, especially when it presents in various parts of the body, can be complex and often requires a multidisciplinary approach to diagnosis and treatment. Given your symptoms and history, it’s essential to consider several factors that may contribute to your condition.

1. Potential Causes of Widespread Pain: Your description of pain in multiple areas, including the knees, abdomen, shoulders, and chest, suggests that there could be several underlying issues at play. Conditions such as fibromyalgia, chronic fatigue syndrome, or even autoimmune disorders can manifest as widespread pain. Additionally, your history of Mediterranean anemia and previous heart issues could indicate that your body is under stress, which may exacerbate pain perception.

2. Blood Circulation and Pain: You mentioned concerns about blood circulation and whether it could be causing your symptoms. Poor circulation can indeed lead to pain, especially in the extremities, and can be associated with conditions like peripheral artery disease. However, since you have a history of heart issues, it’s crucial to rule out any cardiovascular problems that could be contributing to your symptoms. A thorough evaluation by a cardiologist may be warranted if you experience chest pain or shortness of breath.

3. Neurological Considerations: Given the variety of pain locations and the nature of your symptoms, it’s also possible that there are neurological components involved. Conditions such as neuropathy or nerve entrapment syndromes can cause pain that feels widespread but originates from specific nerve pathways. Consulting with a neurologist could provide insights into whether there are underlying nerve issues contributing to your pain.

4. Multidisciplinary Approach: Since your symptoms are widespread and affect multiple systems, it may be beneficial to see a rheumatologist, who specializes in autoimmune and musculoskeletal disorders. They can help determine if there’s an underlying inflammatory or autoimmune condition that could be causing your symptoms. Additionally, a pain management specialist could assist in addressing the pain itself, regardless of the underlying cause.

5. Psychological Factors: Chronic pain can also have psychological components. Stress, anxiety, and depression can amplify the perception of pain and lead to a cycle of discomfort. It might be helpful to consider speaking with a mental health professional who can help you develop coping strategies for managing pain and stress.

6. Diagnostic Testing: Given your symptoms, it may be necessary to undergo a series of diagnostic tests. Blood tests can help assess for inflammatory markers, autoimmune conditions, and anemia. Imaging studies, such as MRIs or CT scans, may be needed to evaluate the joints and soft tissues for any structural issues.

7. Lifestyle Modifications: In addition to seeking medical advice, consider lifestyle modifications that may help alleviate some of your symptoms. Regular low-impact exercise, such as swimming or walking, can improve circulation and reduce pain. Additionally, maintaining a balanced diet rich in anti-inflammatory foods may also be beneficial.

In summary, your symptoms warrant a comprehensive evaluation by multiple specialists, including a rheumatologist, neurologist, and possibly a cardiologist. It’s essential to address both the physical and psychological aspects of your pain to develop an effective treatment plan. Keep a detailed record of your symptoms, including when they occur and any potential triggers, to provide your healthcare providers with the information they need to help you effectively.

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