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Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
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Experience:  Board Certified Family Nurse Practitioner
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battled with leg pain for a couple..endometriosis..taking tramadol

Resolved Question:

I have battled with leg pain for a couple of years now. I suffer horribly from endometriosis and have had 3 surgeries attempting to provide relief of the many pains associated with this condition, however, it hasn't seem to help my leg pain at all. I have currently been taking tramadol to control the pain while my Doctor performs a variety of testing to assure there isn't anything else possibly wrong. She had also found that I had 'diminished pulses" in my legs and wondered what might be the cause. My body seems to be becoming tolerant of the tramadol, however, and I was wondering what alternate medication might be attempted that would be helpful with the pain. My leg pain is far more painful than even my endometriosis pain if that remotely begins to describe how debilitating this condition has become for me. Thanks.
Submitted: 6 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.



Thank you for writing in today. I want to provide you with the best possible information, so I do have a few other questions. I hope you understand. Any other medical conditions or medications not mentioned? Do you have any history of leg trauma? Can you tell me more about your leg pain? What makes it worse/better? When is the pain worse, such as day, night? Is it constant or intermittent? Can you describe the pain, such as stabbing, dull, etc? Any other symptoms not mentioned? What testing has been done or is planned? Please let me know. Lisa

Customer: replied 6 years ago.
Hi-I don't really have any other medical conditions other than what has been effected by my endometriosis. About 5 years ago, I suffered from a miscarriage at 4 months and as if that wasn't horrible enough, the doctor left parts of the baby inside of my uterus, thus causing a variety of problems for me and required an additional surgery 6 months later. As a result I bled for several months, which is what it is believed to have started the endometriosis. I have tried several hormonal therapies, but generally just try to do my best between surgeries, as I would really rather not have a hysterectomy at this time. Medications include a mild fluid pill-triametrene/low dose of synthroid and the orthovera patch (which is probably short term, as I never seem to ever feel very good while taking hormonal therapies. I have had no history of leg trauma, only flat feet-which if you asked my grandmother, she swears that is what causes my leg pain:) Exercising used to make it better, but doesn't seem to help now-actually nothing other than the tramadol offers any relief. High heels, cold temperatures, concrete floors or any kind of stress appear to make it much worse. My pain is constant, being much worse at nighttime. The pain is similar to my legs going to "sleep," or as if they have lost circulation-an aching pressure/pain that makes it even impossible for me to concentrate, sleep or think. Other symptoms include cold feet and purplish skin. No testing has been done thus far, however, I am scheduled to see a neurologist, as well as have a doppler study conducted within the next few weeks. Thanks so much for your help-I can't tell you how much I appreciate it.
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.
I just have a few more questions. I hope you understand. The information will really help me advise you more specifically. Do you smoke? Height/weight? Any issues with swelling in your legs? Do you have any issues with ulcers on your legs or toes? Do you grow hair on your lower legs? Do you have a shiny appearance on your legs? Is there any redness or brown discoloration? Please let me know. Lisa
Customer: replied 6 years ago.
I do not smoke regularly-just socially, which is hardly never-no more than 3 cigarettes per day. My height is 5 foot 5 inches and I weigh 170 pounds; had recently gained weight when I experienced problems with my gall bladder and since having it removed have successfully lost 50 pounds since June 2009. I continue working towards losing weight watching what I eat, as well as continuing to exercise. My legs don't appear to swell ad I have never had ulcers on my legs and toes. I do think actually my legs have a shiny appearance and there is always a discoloration-they are purplish/brownish/reddish and always blotchy unless they're really warm. Hope this information is helpful...thanks again.
PS and Yes I do grow hair on the bottom part of my legs and more slowly on my thighs/top parts of my legs.
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.



Thank you for responding to all of the many, many questions. I hope you understand why I would need to ask all of these questions. Well, with regard to your original question, at this point, it difficult to recommend an alternative medication to treat the pain. At this point, I am convinced that a proper diagnosis must be made in order to treat the pain. I will explain. Your symptoms are actually concerning for a number of problems. However, a vascular issue seems to be the most likely so far. Obviously, you need to have additional testing to confirm this, which you do have scheduled. However, I might be able to illustrate why a proper diagnosis is necessary before recommending any pain management. Let's just say that a patient has a vascular problem. The patient may have pain when the tissues are not receiving enough blood. This type of pain responds better to interventions that improve circulation/perfusion. Sometimes this can be achieved with medications, such as calcium channel blockers to dilate, but sometimes, depending on the situation, surgery is needed. Promoting improved circulation can be the best therapy for this type of pain, rather than agents like tramadol. Now, with this being said, regardless of a diagnosis, just given your situation, I would recommend quitting smoking. I know it is difficult to give up smoking, but smoking is really hard on circulation. Your weight loss efforts and exercise are a great lifestyle change. In addition, just because the symptoms are suggestive of a vascular problem, this is not necessarily the case. It can only be confirmed by proper testing and evaluation. I hope this helps. I know this is alot of information; therefore, if you have additional questions or need clarification, please let me know. Lisa

Customer: replied 6 years ago.
Thanks so much-I greatly appreciate your help-I will continue on this journey to discover what's wrong, as well as how to properly have it treated. Have a great rest of your evening-thanks, Crystal
Expert:  Lisa, MSN, FNP-BC, CCRN replied 6 years ago.
Crystal, hang in there! Getting a proper diagnosis will be key to developing a treatment plan, particularly with regard to your pain. The upcoming tests will be really helpful, even with eliminating possible underlying problems. I wish you the best. Take care. Lisa
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