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Dr. Andrew Rynne

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What causes sudden onset of moderate muscle pain and swollen lymph nodes?

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Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 3197 Questions

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Posted on Fri, 31 Mar 2017 in Pain Management
Question: Sudden onset 2 nights ago of moderate muscle/joint/lymph aching all over body--including bilat legs, hip, bilat arms, shoulders and also head--jaw, headache. No fever, don't feel sick. Discomfort has increased since. I have a Rx for Methadone & neurotin. I've been keeping up with the neurotin as it seems, how ever minor, helping the most. The only thing changed in my medications was that I've been fighting with new insurance since XXXXXXX regarding Cymbalta. I am a nurse and know that to suddenly stop it is not a good thing. So the 2nd wk of February, I decided to wean down on the drug to prevent any problems with going off and giving the insurance people time to work it out. Long story, short, I weaned it from 2xd to 1xd, and then, qod, and now every 4 days--I have 2 left. I finally got the approval (as of today), but it is a mail order (required by the insurance/actually CCF's policy, or they won't pay), I probably won't get it until hopefully the beginning of next wk. Do these sudden symptoms seem related to you with regard to the drug? I work at XXXXXXX Clinic XXXXXXX XXXXXXXXVNS XXXXXXXX in XXXXXXX My work email is YYYY@YYYY . Thank you so much, XXXXX
doctor
Answered by Dr. Matt Wachsman 54 minutes later
Brief Answer:
um... which drug? what pain?

Detailed Answer:
Causality of drug relates to quite alot...ok. EVERYTHING, saying a drug is related to symptoms relates to ever feature of the condition, the drug, the context, the known pharmacology of the pain, etc. Everything.

Several features of pain can be helpful in clarifying what is going on and the next steps for diagnosis and treatment.

Type of pain. Burning mostly means a nerve is having problems. This can be either a sick nerve or a nerve that has had an injury. Electrical, shooting would be others implying nerve source for pain.

Location of pain. There is a lot to this. First, if something goes in the pathway of a nerve, then that is the nerve involved. Nerves are long and the pain is in a belt-like long pathway. Smaller areas are smaller nerves. This also tends to say what might be going on. Obviously if there was an injury to the area and then there was pain outward from it "hit a nerve" would be a possibility. Sick nerves are MULTIPLE areas and tends to be the TIPS of the nerve not the whole nerve

What hurts. Moving a particular way that triggers the pain tells what is hurting. Specifically it can distinguish outward structures like skin, muscles, tendons, joints from deep structures like organs and nerves.

``     Having a diagnosis leads to choice of medicine for the pain. Inflamed outer structures respond to treating inflammation. Inner structures need diagnostic tests because something internal is broken. MRI's.


So, the first question is what is the pain and does it have the features (nerve pain) that would make a nerve pill (cymbalta) more likely to be important. Then there are other drugs that do the same or better (amitryptiline and nortryptiline) for pain.

Decreasing the cymbalta (that is indicated for some types of all over pain) was associated with pain. If it is a resolution of pain that was there before it was started then it just was plain working. If the pain is NEW and wasn't there EVER prior to lowering the dose you'd have to wonder if the drug were connected to CAUSING the pain .. this with narcotics is called "drug withdrawal"; it certainly is UNCOMMON for withdrawal of non-narcotics but it might occur. Then does taking the drug change the pain.

There are many features that can point to the mechanisms that are underlying a situation.



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman 32 minutes later
I'm really unconvinced that you even took the time to read about the problem I'm having.
First of all you say at the beginning and further down in the in your response, "which drug? what pain, what hurts?" I was very clear that it was located throughout my body--muscles, joints, & lymph areas. And that it developed suddenly, did not come on gradually. I DID describe it as an "aching" pain. I did not say sharp, burning or anything like you mentioned--not quite sure why you addressed something I don't have. You were also quite focused on nerve pain...? Again, it is an aching pain. One that makes it hard to sit still without moving the aching areas to provide some relief. I have a congenital spinal stenosis so I do know the difference due to the various types of pain. I did also mention to you that I am a registered nurse, certified CCRN "critical care" with over 20 yrs. experience in the open-heart intensive care unit. Does that make me an expert? ABSOLUTELY NOT which is why I thought I'd try this service to get someone's basic opinion about what might be going on. I did not list all of my diagnoses, as at this point all have been maintained/controlled. The ONLY change is in this sudden symptom & the recent change due to the Cymbalta--which I wondered from your experience if you thought could be related to the decrease in dose of Cymbalta.
Finally, I am NOT challenging you. But I did expect a little better response when I gave you the specifics of what I'm feeling. Or for you to ask me if you were unclear of something. XXXX
doctor
Answered by Dr. Matt Wachsman 52 minutes later
Brief Answer:
It isn't cymbalta

Detailed Answer:
This is of course in the context of general information to someone I am not directly examining. In this context overall information and the general process of making a causality inference is what we would provide. However, if someone wanted better information " I did not list all of my diagnoses, as at this point all have been maintained/controlled." would not produce as good an response as if all information were provided.

The narrow question is about cymbalta.

no.

Or, another way to state it is, it is quite a stretch when the mechanism of the drug, the timing of taking it the type of pain all go against the cause. Reasonably, giving more than a 2 letter answer would be expected and giving the background on the features one would use in assigning causality would be important. Causality is a complex issue.


What would make it a random association that is less likely to be from the drug than from the keyboard?

Cymbalta interacts with nerves. but keyboards interact with muscles and nerves.
"located throughout my body--muscles, joints, & lymph areas"
"I DID describe it as an "aching" pain."

The pain came up not related closely to the titration. The drug did not remove the same pain before.

So, a drug that is in the END part of it's taper. the drug wouldn't be there most of the time. I asked if the drug when taken stopped the pain or asked about a relationship between it. The answer strongly implies not.

There is a relationship between the keyboard. The body position and activity of long typing would affect joints and muscle broadly. This type of pain would occur suddenly and while it would be waxing and waning, it would also stay.

Do I really think it's keyboard use? I didn't when I started, I was using it as an example of an unrelated coincedental cause of pain (which is what I think it is), but I kind of made a convincing case for it. The main point is that it makes a better connection than for cymbalta.

So, no, not cymbalta, and you'd have to wonder about the use of 2 neuropathic pain drugs (cymbalta and neurontin) that if someone didn't have a neuropathic condition then why would someone be taking it. There could be fibromyalgia but since cochran review basically states there is ZERO reason to believe narcotics such as methadone would be helpful in fibromyalgia (or in neuropathic pain either for that matter) in fact I cannot find any professional organization endorsing any narcotic ever for fibromyalgia. Indeed, there is good theoretical reason to expect the use of narcotics in fibromyalgia to produce hypersensitivity to pain generalized throughout the bones, muscle, and joints. Achy type. Not neuropathic type.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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