Unexplained Severe Body Pain: A 71-Year-Old's Medical Mystery

Q: Unexplained Severe Body Pain: A 71-Year-Old's Medical Mystery

Hello Mr. <br>Dong： Based on the symptoms mentioned, it is recommended to consult with an immunology and rheumatology specialist. <br>If the cause is still not identified, please seek a detailed examination from a neurologist.

Intermittent generalized bone pain?

Hello Doctor, my father is 71 years old.
He has seen several specialists in the hospital, but we have not been able to find the cause of his condition, which has left our family and the patient feeling helpless and discouraged.
He has been receiving treatment in the hematology department for polycythemia, but recent blood tests have shown anemia.
We have scheduled a stool test for occult blood.
Recently, he has been experiencing severe and intermittent pain throughout his body, starting from his thighs and radiating upwards, including his arms.
During these episodes, he experiences weakness in his limbs, making it difficult for him to grasp objects or stand and walk.
His heart rate also increases, and he feels like he might faint at any moment.
The only relief he finds is from over-the-counter pain medication.
Initially, we suspected it might be a sign of a myocardial infarction, so we consulted a cardiologist.
An electrocardiogram was performed, which came back normal, and we were advised to see a neurologist.
However, after hearing our concerns, the neurologist stated that it was not within his specialty and recommended that we return to hematology.
We then expedited the stool test that had been previously arranged by the hematology department and made another appointment with them.
The hematologist reviewed the stool test results, which indicated the presence of hemoglobin in the stool and confirmed the anemia.
He administered a blood transfusion and suggested we consult a gastroenterologist and an orthopedic specialist.
Before seeing these two specialists, my father had a severe episode and we went to the emergency department.
The emergency physician performed an X-ray but could not identify any issues, leaving my father in pain.
When we asked if he could take over-the-counter pain medication, the doctor agreed, and it was only after taking that medication that he found some relief.
Later that day, the emergency physician referred my father back to hematology, suspecting a possible blood cancer.
When we saw the hematologist that day, he assured us that it was definitely not blood cancer but still recommended that we consult the gastroenterologist and orthopedic specialist.
Following the advice of a nurse and a volunteer, we also visited a family medicine physician, but still could not determine the cause of his symptoms.
The gastroenterologist also could not find any answers and referred us back to the neurologist.
We are truly at a loss for what to do next, as we have been unable to identify the cause of his severe pain, which occurs unpredictably every day.
We feel very helpless and would like to seek your advice on what steps we should take next.

Mr. Dong, 40~49 year old female. Ask Date: 2023/12/14

Dr. Cai Zongzhang reply Neurology

Hello Mr.
Dong: Based on the symptoms mentioned, it is recommended to consult with an immunology and rheumatology specialist.
If the cause is still not identified, please seek a detailed examination from a neurologist.

Reply Date: 2023/12/14

More Info

I'm sorry to hear about your father's ongoing health issues and the challenges your family is facing in finding a diagnosis. It can be incredibly frustrating and disheartening when multiple specialists are unable to pinpoint the cause of severe pain, especially when it affects daily life so significantly.

Given your father's age and the complexity of his symptoms, it’s important to consider a few potential avenues for further investigation. The severe, intermittent body pain he is experiencing, along with weakness and the sensation of impending faintness, could be indicative of several underlying conditions. Here are some possibilities to consider:
1. Chronic Pain Syndromes: Conditions such as fibromyalgia or myofascial pain syndrome could lead to widespread pain without clear structural abnormalities. These syndromes often require a multidisciplinary approach for management, including pain specialists, physical therapy, and sometimes psychological support.

2. Neurological Disorders: While the neurologist may have suggested that your father's symptoms do not fall under their specialty, it might be worthwhile to seek a second opinion from another neurologist. Conditions such as neuropathy or other nerve-related issues could manifest as severe pain and weakness.

3. Autoimmune Disorders: Conditions like rheumatoid arthritis or lupus can cause systemic symptoms, including severe pain and fatigue. Blood tests for inflammatory markers or specific autoantibodies might be warranted.

4. Endocrine Issues: Thyroid dysfunction or adrenal insufficiency can lead to fatigue, weakness, and pain. A comprehensive metabolic panel could help rule out these conditions.

5. Hematological Concerns: Since your father has a history of blood disorders, it’s crucial to continue monitoring his blood counts and consider further testing for conditions like myelodysplastic syndromes or other bone marrow disorders, especially given the recent findings of blood insufficiency.

6. Gastrointestinal Issues: Given the mention of blood in the stool, it’s essential to ensure that there are no underlying gastrointestinal issues, such as ulcers or malignancies, that could be contributing to his symptoms. A gastroenterologist may recommend further imaging or endoscopic procedures.

7. Psychological Factors: Chronic pain can sometimes be exacerbated by psychological factors such as anxiety or depression. A referral to a mental health professional could be beneficial for a holistic approach to his care.

In terms of immediate management, since over-the-counter pain medications have provided some relief, it may be worth discussing with your healthcare provider about a more structured pain management plan. This could include prescription medications, physical therapy, or even alternative therapies such as acupuncture or chiropractic care, depending on what is deemed appropriate.

Lastly, if your father’s symptoms continue to worsen or if new symptoms arise, it may be necessary to revisit the emergency department for further evaluation. Sometimes, acute changes in condition can provide new insights into a diagnosis.

In summary, while the journey to a diagnosis can be long and frustrating, it’s essential to remain persistent and advocate for comprehensive evaluations across various specialties. Keeping a detailed log of symptoms, triggers, and any changes can also be helpful for healthcare providers in identifying patterns that may lead to a diagnosis. I hope this information provides some guidance and support as you navigate your father's healthcare journey.

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