Chronic Pain and Burning Sensations in Neurological Disorders

Generalized tingling and burning sensation?

Hello, I experience a prickling, electric sensation and pain in my limbs and back when exposed to higher temperatures or when I feel like I am about to sweat.
I have been hospitalized and undergone multiple tests, including blood tests, immunological assessments, and nerve conduction studies, all of which were largely normal.
However, skin biopsies from different facilities consistently show chronic perivascular inflammation with lymphohistiocytic infiltration.
Sympathetic nerve function tests indicate that only three branches remain functional, and currently, my skin is very dry with almost no sweating.
When I encounter high temperatures or feel anxious, I experience unbearable widespread prickling and my skin feels very hot.
I have taken a lot of pain medication and anticonvulsants, but they provide minimal improvement.
Only cold water seems to alleviate the burning sensation, which can last for several hours each day.
What treatment options are available for my condition? Thank you.
{I have been waiting for the nerve biopsy report for over three months.}

Da Tou, 30~39 year old female. Ask Date: 2005/11/06

Dr. Huang Yingzhe reply Neurology

Dear Dr.
Huang Ying-Che, Director of the Neurology Department at Tainan Hospital, Executive Yuan Health Department:
How should we proceed with treatment? It is best to first confirm the diagnosis.
If that is not possible, symptomatic treatment can be utilized.
As you are already using antiepileptic medications, B-complex vitamins, and possibly tricyclic antidepressants or sedatives like Lexotan/Xamax, these can be considered.
However, I am unsure of the specific approach.
If there is a confirmed diagnosis, please let me know.
Thank you.
Wishing you good health and all the best from Tainan Hospital!

Reply Date: 2005/11/06

More Info

Chronic pain and burning sensations, particularly in the context of neurological disorders, can be complex and multifaceted. Based on your description, it appears that you are experiencing significant discomfort characterized by a burning sensation and electric shock-like pain in your limbs and back, particularly when exposed to higher temperatures or during times of stress. This symptomatology can be indicative of several underlying conditions, and understanding the potential causes and treatment options is essential.

Firstly, the presence of "chronic perivascular inflammation" as noted in your skin biopsy suggests an inflammatory process that may be affecting the small blood vessels in your skin. This type of inflammation can lead to a variety of symptoms, including pain, burning sensations, and altered sweating responses. The infiltration of lymphocytes and histiocytes indicates an immune response that could be contributing to your symptoms. Chronic inflammation can disrupt normal nerve function, potentially leading to neuropathic pain, which is often described as burning, tingling, or electric shock-like sensations.

The fact that you have reduced sweating and dry skin may also point towards a dysfunction in the autonomic nervous system, which regulates involuntary bodily functions, including sweating. This condition can lead to a phenomenon known as "hyperhidrosis" or "anhidrosis," where the body fails to produce adequate sweat in response to heat or stress, exacerbating feelings of discomfort and pain. The autonomic nervous system is divided into the sympathetic and parasympathetic systems, and an imbalance can lead to heightened sensitivity to pain and temperature changes.

In terms of management, it is crucial to adopt a multidisciplinary approach. Here are some potential avenues for treatment:
1. Pain Management: Since you have mentioned the use of pain medications with limited relief, it may be beneficial to consult a pain specialist who can explore alternative pain management strategies. This could include medications such as anticonvulsants (e.g., gabapentin or pregabalin) or antidepressants (e.g., duloxetine) that are often effective in treating neuropathic pain.

2. Physical Therapy: Engaging in physical therapy may help improve your overall function and reduce pain. A physical therapist can design a program tailored to your needs, focusing on gentle stretching, strengthening exercises, and modalities such as heat or cold therapy.

3. Neurological Evaluation: Given the complexity of your symptoms, a thorough evaluation by a neurologist is essential. They may consider additional diagnostic tests, such as nerve conduction studies or electromyography (EMG), to assess the function of your nerves and muscles.

4. Stress Management Techniques: Since you noted that stress exacerbates your symptoms, incorporating stress management techniques such as mindfulness, meditation, or cognitive-behavioral therapy (CBT) may help reduce your overall pain perception and improve your quality of life.

5. Lifestyle Modifications: Staying hydrated, maintaining a balanced diet, and avoiding known triggers (such as extreme temperatures) can also be beneficial. Regular, gentle exercise may help improve circulation and reduce inflammation.

6. Follow-Up on Biopsy Results: It is important to follow up on your skin biopsy results and any additional tests that may provide further insight into your condition. Understanding the underlying cause of your symptoms is crucial for effective treatment.

In conclusion, chronic pain and burning sensations in the context of neurological disorders can be challenging to manage. A comprehensive approach that includes medical evaluation, pain management, physical therapy, and lifestyle modifications can help improve your symptoms and overall well-being. It is essential to work closely with your healthcare providers to develop a personalized treatment plan that addresses your specific needs.

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