What causes nerve pain,numbness hands and legs and what should be done for the same?
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I have been getting nerve pain for over 6 months now. Initially in one wrist then in both arms/hands and eventually legs too although arms worse - numbness, tingling and as well as electrical type pain which runs from the back of my head, down my neck & arms into my hands - this is particular can last for days at a time. I was initially tested for carpal tunnel was was negative then told it was herniated discs in both my cervical and lumbar spine but MRIs have proved negative to that. I was started on 900mg gabapentin a month ago and am now on 1800mg a day and although this has helped to an extent am still gettings all these symptoms. I have now been told physio and some swimming should sort it out but I feel I should push to see a neurologist - what do you think?
Posted Mon, 30 Dec 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I agree that you need to see a neurologist, and required detailed neurological evaluation, to confirm the diagnosis and start appropriate treatment. There are a few common possibilities in your case: 1. Cervical and lumbosacral radiculopathy- in this case, the nerve roots arising from the neck and low back regions are affected (which travel to arms and legs respectively). The commonest cause for this would be herniated discs, but can also occur due to auto-immune disease, vasculitis, infection, etc. 2. Spinal cord disease, as is seen with multiple sclerosis. But MRI would be positive, and would show the MS lesions. If the investigations are normal, then, another possibility would be fibromyalgia, where widespread pain, tingling, numbness, etc may occur. Gabapentin may be continued for now. Other medications that could help are pregabalin or duloxetine capsules. I hope my answer helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in
Follow-up: What causes nerve pain,numbness hands and legs and what should be done for the same? 1 hour later
Thank you for your reply. I am aware that some of the symptoms could point to MS. After the carpal tunnel tests I was referred to a rheumatologist because the orthopedic surgeon I saw thought it was arthritis. It was the rheumatologist who did the MRIs and said after that 'your spine is structurally fine - there are no disc herniations and there are no trapped nerves' - would that then rule out cervical and lumbosacral radiculopathy? And do you think he would have looked for lesions or are they something that you only see if you are specifically looking for them (which he wasn't!). I saw my GP today and he also agrees I need to see a neurologist. I will look up fibromyalgia. Do any of the conditions you mentioned give you electrical sensations which are far more pronounced than the tingling and numbness?
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer: Thank you for getting back. Detailed Answer: 1. In your case, herniated discs as cause for cervical and lumbosacral radiculopathy have been ruled out. For vasculitis, some blood tests such as ANA, CRP, anti-ds DNA, etc may be required. For infection, a lumbar puncture and contrast MRI may be required. 2. Yes, a radiologist and neurologist experienced in MS should look at the MRIs, as the MS lesions would be missed by the "non-trained" eyes. 3. Yes, all those conditions could cause electrical sensations more pronounced than tingling and numbness. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)