Muscle Pain: Exploring Neurological and Cardiac Symptoms

Q: Muscle Pain: Exploring Neurological and Cardiac Symptoms

Hello Mr. <br>Lucas： You mentioned that "the pain is noticeably felt during pressure," which may indicate a muscular issue. <br>It is advisable to consult a rehabilitation physician to discuss your daily posture. <br>Pain specialists typically provide nerve block treatments after

Muscle pain

There are several main issues: 1.
Palpitations, occasionally feeling a strong heartbeat; 2.
A sensation of electric shock throughout the body when startled; 3.
Intermittent sharp pain and soreness in the left upper body; 4.
Pain in the left upper body when exerting, with pain extending from the chest to the back; 5.
Numbness in the left palm and left foot; 6.
Pain in the finger joints of the right hand; 7.
A sudden body jerk when nearly falling asleep.
It is uncertain whether these symptoms are related, but they appeared simultaneously and have not occurred before, so they are noted together.

Treatment: I have consulted a cardiologist and undergone an electrocardiogram, ultrasound, and CT scan, all of which showed no abnormalities.
I have also seen a neurologist, who stated that these symptoms are unrelated to neurology and discharged me.
I have consulted a psychiatry department and was assessed to have autonomic nervous system dysregulation, currently taking SSRI medication.

Other details: 1.
The sharp pain occurs at the left chest, approximately at the 5 o'clock position relative to the nipple, about two finger widths wide, above the ribs; pressing this area elicits significant pain, while the sharp pain is intermittent when not pressed; there is tenderness at the intersection of the posterior axillary line and the latissimus dorsi.
2.
Occasionally, the symptoms are accompanied by numbness in the left palm and foot, and pain in the finger joints of the right hand.
3.
The symptoms are not persistent; they can last for a short duration, possibly disappearing in about 10 minutes to half an hour, and symptoms only occur during episodes.
4.
If the left chest muscle is exerted (e.g., during bench pressing or push-ups), there is a high likelihood of an immediate episode.

Timeline: Symptoms began about a week after receiving the second vaccine dose in April 2022, occurring approximately 2-3 times daily for about a year, gradually increasing in interval to 1-2 times every one to two weeks, and sometimes only once a month.
The last episode before February 22, 2024, was in October 2023.
During the episode on February 22, 2024, the electric shock symptom was absent.

Questions: 1.
I am currently considering consulting a pain specialist to check for possible muscle or nerve issues, but since the episodes are intermittent, I am uncertain if this is appropriate? 2.
To be honest, I am also unsure if the SSRI medication is effective, as the frequency of episodes had already been gradually increasing before starting the medication.
Are there any other tests or treatment recommendations? Thank you for taking the time to respond!

Lucas, 30~39 year old female. Ask Date: 2024/02/27

Dr. Jiang Junyi reply Neurology

Hello Mr.
Lucas: You mentioned that "the pain is noticeably felt during pressure," which may indicate a muscular issue.
It is advisable to consult a rehabilitation physician to discuss your daily posture.
Pain specialists typically provide nerve block treatments after rehabilitation and medication have proven ineffective.
SNRIs are more effective for pain relief.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi cares about you.

Reply Date: 2024/02/27

More Info

Understanding muscle pain, especially when it is accompanied by neurological and cardiac symptoms, can be quite complex. Your symptoms, including palpitations, sensations of electric shocks, left-sided pain, and numbness, raise several important considerations.
Firstly, it is essential to differentiate between cardiac and musculoskeletal origins of your symptoms. The fact that you have undergone thorough cardiac evaluations, including ECG, echocardiogram, and CT scans, which returned normal results, is reassuring. This significantly reduces the likelihood of a serious cardiac condition, such as coronary artery disease or significant valvular heart disease, especially given your age and previous heart history. However, it is crucial to remain vigilant, as symptoms can sometimes overlap.

Your description of the pain being localized to the left side of your chest, with a sharp, pressing quality that worsens with exertion, suggests a potential musculoskeletal origin. Conditions such as costochondritis, which is inflammation of the cartilage connecting the ribs to the sternum, or muscle strain, could explain your symptoms. The fact that pressing on certain areas exacerbates the pain further supports this hypothesis. Additionally, the involvement of your left arm and hand could indicate referred pain or nerve irritation, possibly from a cervical spine issue or thoracic outlet syndrome.

The sensations of electric shocks and the feeling of your body shaking as you are about to fall asleep could be related to anxiety or a hyperactive autonomic nervous system. Anxiety can manifest physically in various ways, including palpitations and muscle tension, which might explain the discomfort you are experiencing. The diagnosis of autonomic dysregulation aligns with these symptoms, as it can lead to a variety of physical manifestations, including pain and discomfort.

Regarding your treatment with SSRIs, these medications can be effective for anxiety and related symptoms, but their efficacy can vary from person to person. If you feel that the SSRIs are not adequately addressing your symptoms, it may be worth discussing alternative treatments with your healthcare provider. Options could include cognitive-behavioral therapy (CBT), which has been shown to be effective for anxiety and chronic pain management, or exploring other classes of medications, such as SNRIs, which may provide better relief for pain.

Considering your symptoms are intermittent, consulting a pain specialist could be beneficial. They can help determine if there are underlying musculoskeletal or neurological issues contributing to your pain. A multidisciplinary approach, including physical therapy, could also be advantageous. Physical therapists can provide exercises to strengthen the muscles around your chest and back, which may alleviate some of the pain.

In summary, while your symptoms may seem alarming, the thorough evaluations you have undergone suggest a non-cardiac origin. It would be prudent to continue monitoring your symptoms and consider a referral to a pain specialist or physical therapist. Additionally, addressing any underlying anxiety through therapy or medication adjustments may help alleviate some of the physical symptoms you are experiencing. Always communicate openly with your healthcare providers about your concerns and the effectiveness of your current treatment plan.

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