Systemic Electric Pain: A Rare Disease Overview

Systemic electric shock-like pain?

Symptoms: Hello, I experience a tingling, electric shock sensation and a crawling pain in my limbs and back when exposed to higher temperatures or during times of stress.
I have been hospitalized multiple times for 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 exposed to high temperatures or under stress, I experience unbearable full-body tingling and my skin feels very hot.
I have been taking a lot of pain medications, anticonvulsants, and antidepressants, which have provided minimal improvement.
Only methycobalamin, taken for three months, has slightly reduced the pain.
The burning sensation can only be alleviated by splashing water, and it can last for several hours each day.
How should I be treated? Thank you.
Duration: The onset of symptoms has been 1 year and 4 months, with pain lasting longer as temperatures rise.
Additional information: Nerve biopsy shows moderate inflammation with no identifiable cause.

A-Hsiung, 30~39 year old female. Ask Date: 2006/04/10

Dr. Chen Shunsheng reply Rare Disease

Pure sensory polyneuropathy and/or sympathetic autonomic neuropathy.
The causes include congenital or hereditary factors, metabolic disorders (such as amyloidosis), toxic factors (such as tropical marine toxins), and immune abnormalities, among others.
Please visit the neurology department at a medical center for evaluation.

Reply Date: 2006/04/10

More Info

Understanding systemic electric pain, particularly in the context of rare diseases, can be quite complex. The symptoms you describe—such as the electric shock-like sensations, pain, and the feeling of insects crawling on the skin—are indicative of a sensory neuropathy, possibly combined with autonomic dysfunction. The chronic perivascular inflammation observed in your skin biopsies suggests an underlying inflammatory process affecting the nerves.

Your condition seems to align with what is known as "small fiber neuropathy," which primarily affects the small nerve fibers responsible for transmitting pain and temperature sensations. This condition can lead to symptoms like burning pain, allodynia (pain from stimuli that typically do not provoke pain), and autonomic symptoms such as sweating abnormalities. The fact that your symptoms worsen with heat and stress is also consistent with this type of neuropathy, as these factors can exacerbate nerve sensitivity.

The differential diagnosis for your symptoms can include various etiologies, such as autoimmune disorders, metabolic conditions, genetic predispositions, or even toxic exposures. Given the chronic inflammation noted in your skin biopsies, it may be worthwhile to explore autoimmune conditions further, as they can often present with similar symptoms. Conditions like Sjögren's syndrome or lupus could potentially lead to the symptoms you are experiencing, especially if there are other systemic signs or symptoms.

In terms of treatment, it is crucial to address both the pain and the underlying cause of the neuropathy. Since you have already tried several medications, including pain relievers and antidepressants, it may be beneficial to consider a multidisciplinary approach. This could involve:
1. Neurology Consultation: A thorough evaluation by a neurologist specializing in neuropathies can provide insights into potential underlying causes and treatment options. They may recommend additional tests, such as genetic testing or more specialized blood tests, to rule out specific conditions.

2. Pain Management: Medications such as gabapentin or pregabalin, which are often used for neuropathic pain, may provide relief. Additionally, topical treatments like capsaicin cream or lidocaine patches can be helpful for localized pain.

3. Physical Therapy: Engaging in physical therapy can help improve overall function and may assist in managing pain through various modalities, including heat therapy, electrical stimulation, and exercises tailored to your condition.

4. Lifestyle Modifications: Stress management techniques, such as mindfulness, yoga, or cognitive-behavioral therapy, can help reduce the impact of stress on your symptoms. Staying cool and avoiding triggers that exacerbate your symptoms is also essential.

5. Alternative Therapies: Some patients find relief through acupuncture, chiropractic care, or other complementary therapies. While these should not replace conventional treatments, they may provide additional symptom relief.

6. Follow-Up: Regular follow-up with your healthcare provider is essential to monitor your condition and adjust treatment plans as necessary.

In conclusion, while systemic electric pain can be challenging to manage, a comprehensive approach that includes medical evaluation, pain management strategies, and lifestyle modifications can significantly improve your quality of life. It is essential to work closely with your healthcare team to tailor a treatment plan that addresses both your symptoms and any underlying conditions.

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