Neuropathic Pain: Which Specialist Should You See?

Suspected neuropathic pain - unsure which specialty to consult?

Hello, Dr.
Jiang.
I apologize for bothering you.
My mother and grandmother have both reported experiencing "neuropathic pain" after reaching a certain age.
They have occasional episodes, a few times a year, where a specific part of their body experiences intermittent sharp pain, which disrupts their sleep at night.
However, the affected body parts are not consistent each time.
I am unsure if this could be hereditary.
Neither my mother nor grandmother has sought aggressive medical treatment; they simply endure the pain for a day or two, after which it resolves on its own.

Recently, I have experienced similar intermittent sharp pain over the past few months (previously, my pain was mainly due to fatigue leading to headaches).
The first occurrence happened at night while I was sleeping, with sharp pain in the top of my foot, making it difficult to sleep.
Initially, I thought it might be due to daytime exercise, possibly a mild sprain.
However, the next day, I noticed that it felt like a part of the tissue in my foot was hurting, with the pain coming in waves, unlike the pain I experienced from a sprained ankle in the past.

In the last six months, I have had several episodes of this sharp pain, affecting both the top of my foot and my back, and the timing of these episodes does not always coincide with physical activity.
I began to suspect it might be the "neuropathic pain" my mother mentioned.
Typically, these episodes start when I am falling asleep at night and continue into the next day, lasting about two days before resolving.

In the past two days, I have experienced sharp pain in a specific area of my right knee, coinciding with a headache.
Again, this pain started at night while I was trying to sleep, and it has continued into the day, coming in waves.
This situation is quite concerning for me, and I am unsure if I should see a doctor for an examination.
If I should, which specialty would be most appropriate?
It seems that my legs and feet are more frequently affected by this sharp pain, while the intermittent pain in my back has occurred only once.
I worry that this discomfort might simply be due to my regular exercise (simple bodyweight core exercises or aerobic activities) combined with recent life stressors, and I might be overreacting.
However, there have been instances of sharp pain occurring even when I have not exercised.

Therefore, I would like to ask you, what would be the best course of action for someone in my situation? Should I continue to observe the symptoms (the pain is tolerable but affects my sleep, so would over-the-counter pain relievers be advisable)? Or if I need to see a doctor, which specialty should I prioritize (perhaps rehabilitation or neurology)? I appreciate your time and hope I haven't caused too much inconvenience.
Thank you!

Miss Peng, 20~29 year old female. Ask Date: 2022/04/13

Dr. Jiang Junyi reply Neurology

Dear Miss Peng,
You mentioned that "the pain usually starts at night when falling asleep and continues into the next day, occurring in episodes, and typically resolves within two days." Your symptoms may suggest Restless Legs Syndrome (RLS).
The etiology of RLS is related to genetic factors, abnormalities in brain iron metabolism, and dysfunction of the dopamine pathways.
1.
Primary RLS, which is more closely associated with genetics, often has a family history.
2.
Secondary RLS is associated with conditions such as iron deficiency, folate deficiency, end-stage renal disease, diabetes, rheumatic autoimmune diseases (such as rheumatoid arthritis and systemic lupus erythematosus), pulmonary diseases (such as chronic obstructive pulmonary disease and pulmonary hypertension), neurological disorders (such as Parkinson's disease, multiple sclerosis, peripheral neuropathy, migraines, stroke, and transient ischemic attacks), gastrointestinal diseases (such as post-gastric surgery), smoking, alcohol consumption, caffeine intake, and medication use (such as antihistamines, dopamine antagonists, and antidepressants).
Due to the variety of potential causes, further evaluation and diagnosis are necessary.
I recommend discussing your symptoms and treatment options with a neurologist.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi, Taoyuan Medical Center

Reply Date: 2022/04/13

More Info

Understanding neuropathic pain and its implications can be quite complex, especially when it involves multiple family members experiencing similar symptoms. Based on your description, it seems that both your mother and grandmother have reported episodes of "nerve pain," which you are now also experiencing. This raises several important considerations regarding the nature of neuropathic pain, potential hereditary factors, and the appropriate medical specialists to consult.

Neuropathic pain is often characterized by sensations such as burning, tingling, or sharp, shooting pains that can occur without any apparent physical cause. It can arise from various conditions, including nerve injuries, diabetes, infections, or even as a side effect of certain medications. The fact that your family members have experienced similar symptoms could suggest a genetic predisposition to conditions that affect nerve function, but it is essential to note that not all cases of neuropathic pain are hereditary.

Your symptoms, particularly the episodic nature of the pain and its occurrence during rest or sleep, could indicate a neuropathic component. The fact that the pain is not localized to a specific area and can vary in intensity and location adds to the complexity of the diagnosis. It is also worth considering that stress and lifestyle factors, such as physical activity or lack thereof, can exacerbate or trigger these symptoms.

Given your situation, it is advisable to consult a medical professional for a thorough evaluation. The first step would typically be to see a neurologist, as they specialize in disorders of the nervous system, including neuropathic pain. A neurologist can conduct a comprehensive assessment, which may include a physical examination, a review of your medical history, and possibly diagnostic tests such as nerve conduction studies or imaging studies to rule out any underlying conditions.

If the neurologist determines that your symptoms are related to nerve dysfunction, they may recommend various treatment options. These can include medications specifically designed to manage neuropathic pain, such as anticonvulsants (like gabapentin or pregabalin) or antidepressants (such as amitriptyline). Physical therapy may also be beneficial, especially if there are any musculoskeletal components to your pain.

In the meantime, if your pain is manageable, over-the-counter pain relievers like acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) may provide temporary relief. However, it is crucial to avoid self-medicating with stronger prescription medications without professional guidance, as this can lead to dependency or other complications.

Additionally, lifestyle modifications can play a significant role in managing pain. Regular exercise, stress management techniques (such as mindfulness or yoga), and maintaining a healthy diet can contribute positively to your overall well-being and potentially reduce the frequency and intensity of pain episodes.

In summary, while your symptoms may suggest a neuropathic origin, a definitive diagnosis can only be made through a professional evaluation. Consulting a neurologist would be a prudent first step, and they can guide you through the necessary assessments and treatment options. Remember, early intervention can often lead to better outcomes, so seeking help sooner rather than later is advisable.

Similar Q&A

Should I See a Neurologist or a Rehabilitation Specialist for Hip Pain?

Hello, I fell a long time ago and injured my left hip. Since then, I've experienced a tingling sensation in my left hip. I consulted a neurologist who mentioned that there was nerve damage. In recent years, the pain has worsened to the point where it hurts even when walking ...

Dr. Li Yanheng reply Rehabilitation
Consider a rehabilitation medicine evaluation to check for any muscle compression of peripheral nerves.

Which Specialist to See for Sacral Nerve Issues: Neurology or Orthopedics?

I think it might really be a problem with the lumbar nerve as the doctor mentioned! Which specialty should I see? Neurology or Orthopedics? However, I previously visited Dr. Hsieh Ching-Hsiang in the Orthopedic department at Yang Ming Hospital. He looked at the X-rays and said th...

Dr. Ke Fangxu reply Surgery
If a neurological issue is suspected, a neurologist should be the first choice. However, some orthopedic and rehabilitation specialists also have considerable experience with chronic pain. Wishing you a speedy recovery.

Persistent Foot Pain: When to Consult an Orthopedic Specialist

I have been experiencing soreness, numbness, and pain in the soles of my feet. I have seen a neurosurgeon several times, but the medication has been ineffective, and the discomfort is getting worse. Should I consider seeing an orthopedic specialist?

Dr. Yang Zhengfan reply Orthopedics
Dear May, I believe you may be experiencing sciatica. Typical sciatica is caused by a herniated disc between the vertebrae, which leads to nerve compression, resulting in symptoms such as pain, numbness, and tingling in the feet. I recommend that you consult an orthopedic special...

Which Specialist to See for Leg Pain and Cramps?

You should see an orthopedic specialist or a neurologist for your symptoms.

Dr. Chen Bozhang reply Family Medicine
Hello! It is recommended to consult with a family medicine clinic first. Thank you!