Intermittent Nerve Pain: A 48-Year Journey

Intermittent neuralgia

My symptoms began at the age of 20, and after 48 years, I have visited many hospitals and undergone numerous tests, yet no answers have been found.
About 90% of the symptoms occur in both feet, characterized by intermittent sharp pain.
The pain comes and goes, and pressing or striking the area does not elicit pain.
If I refrain from taking painkillers, the pain intensifies until I require an injection for relief.
During the next episode, the pain shifts to different areas of the feet, which appear completely normal with no redness or swelling.
When I am not in pain, I can hike and run without any issues.
The phenomena that easily trigger foot pain include (in order of high probability): 1.
Food (vegetables, fruits, soy milk, yogurt, honey, etc.) 2.
A few days after ejaculation 3.
Episodes occurring during sleep (including naps) 4.
Rainy days (sometimes, but not consistently).
Thank you for your guidance, Doctor!

Gao Deng, 60~69 year old female. Ask Date: 2015/10/21

Dr. Gao Chunde reply Neurology

Based on your symptom description, it is likely not a peripheral nerve issue, but rather something within the brain, resembling the nature of Restless Legs Syndrome.
There are many possible causes, including iron deficiency, magnesium deficiency, liver and kidney dysfunction, thyroid disorders, autoimmune conditions, sleep apnea, Parkinson's disease, among others.
Several medications can also contribute to these symptoms.
You can search online for more related information and references.

Reply Date: 2015/10/21

More Info

Intermittent nerve pain, especially when it has persisted for decades, can be a complex and frustrating condition for both patients and healthcare providers. Your description of symptoms that began at the age of 20 and have continued for 48 years suggests a chronic issue that may involve multiple factors, including neurological, psychological, and possibly even dietary influences.

From what you’ve described, the intermittent nature of your pain, which is predominantly located in your feet, raises several considerations. The fact that the pain can shift locations and that there are periods of complete normalcy in between episodes suggests that this may not be a straightforward case of peripheral neuropathy or a specific nerve injury. Instead, it could be related to a condition known as neuropathic pain, which can be triggered by various stimuli or conditions.

Potential Causes of Your Symptoms
1. Neuropathic Pain: This type of pain arises from damage to the nervous system and can manifest as shooting, burning, or stabbing sensations. It is often chronic and can be exacerbated by stress, certain foods, or even changes in weather, which aligns with your observations about pain triggers.

2. Dietary Influences: You mentioned that certain foods, including vegetables, fruits, and dairy products, seem to correlate with your pain episodes. This could suggest a possible food sensitivity or intolerance, which may not be immediately apparent through standard allergy testing. Keeping a detailed food diary could help identify specific triggers.

3. Psychological Factors: Chronic pain can often be exacerbated by psychological stressors. The fact that your symptoms can occur during sleep or after ejaculation may indicate a connection to autonomic nervous system responses, which can be influenced by stress and anxiety.

4. Weather Sensitivity: Many individuals with chronic pain conditions report that changes in weather, particularly humidity and temperature, can influence their pain levels. This could be related to changes in barometric pressure affecting nerve sensitivity.

Diagnostic Considerations
Given the extensive duration of your symptoms and the lack of definitive findings from numerous tests, it may be beneficial to explore a multidisciplinary approach to diagnosis and treatment. Here are some steps you might consider:
- Neurological Evaluation: A thorough evaluation by a neurologist specializing in pain management may provide insights into potential nerve-related issues that have not been previously identified.

- Pain Management Specialist: Consulting with a pain management specialist can offer additional treatment options, including medications specifically for neuropathic pain, such as gabapentin or pregabalin, which you may not have tried yet.

- Psychological Support: Engaging with a psychologist or psychiatrist who specializes in chronic pain can help address any underlying psychological factors that may be contributing to your pain experience.

- Dietary Consultation: A consultation with a registered dietitian could help identify any dietary triggers and develop a nutrition plan that minimizes your symptoms.

Treatment Options
1. Medications: As mentioned, medications like gabapentin or pregabalin can be effective for neuropathic pain. Other options include antidepressants that can help with pain relief, even in the absence of depression.

2. Physical Therapy: A physical therapist can work with you to develop a tailored exercise program that may help alleviate symptoms and improve overall function.

3. Alternative Therapies: Techniques such as acupuncture, chiropractic care, or even mindfulness meditation may provide relief for some individuals with chronic pain.

4. Lifestyle Modifications: Regular exercise, stress management techniques, and a balanced diet can play a significant role in managing chronic pain.

Conclusion
Chronic intermittent nerve pain is a multifaceted condition that often requires a comprehensive approach to diagnosis and treatment. Given your long history of symptoms, it is crucial to continue seeking care from healthcare professionals who are willing to explore all potential avenues for relief. Keeping a detailed record of your symptoms, triggers, and any treatments you have tried can also be invaluable in guiding your healthcare team toward a more effective management plan.

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