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Ask Dr. Sophie :: Medicine & Neurolog...

Dr. Sophie :: Medicine & Neurology
Dr. Sophie :: Medicine & Neurology, Doctor
Category: Medical
Satisfied Customers: 2951
Experience:  Neurologist :: Clinical Neurophysiologist :: University of California.
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What Causes Constant Joint And Muscle Pain?

Resolved Question:

I've had constant muscle twitching, fasciculations & spasms, with muscle pain & weakness, & joint pain for 2 years now. It started quickly. I constantly feel like I have an electrical charge going through my body just under the skin. I also have a constant flu-like feeling. I have some pins and needles and icy/hot sensations in all my limbs. Recently I am swelling a lot in fingers toes hands & feet. I have tried everything I can, every doctor. Tests come back normal. ANA is positive. I have high blood pressure most of the time on meds, but whenever I get off the latest med (pristique, lyrica, savella), the blood pressure goes back to normal. I have hot flashes and sweats. I'm extremely weak. My whole life has changed. Can't walk more than a block, and can't lift things. I don't have any fibromyalgia touch points, but I always feel like someone has beat my bones with a bat. Muscles are stiff, tight & burning since the start like I just did a 4 hour workout or ran a marathon! Ideas?

Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Sophie :: Medicine & Neurology replied 4 years ago.

Hello,

What other "tests came back normal"? (can you list the test?)


Are your periods regular?


Customer: replied 4 years ago.

Kidney/Liver OK

Cholesterol is borderline

Hormone and Estrogen tests OK

24 hour Urine OK

Heavy metals poisoning (hair analysis and blood work) OK

Stool sample OK

Intestinal Biopsy OK

Mammogram and ultrasound (this was a separate issue that my Dr wanted me to have checked out) - I have fibroid tumors that need to be removed regularly - otherwise OK.

Thyroid (High for me, but within top of normal range) - All 3 of my sisters have thyroid problems.

EMG-nerve conduction OK

Sonogram of heart - OK 16 motnhs ago (he said I have a small hole in a valve, and I have a slightly enlarged heart. That was 14 months ago. I am going in again Monday.)

MRI of head, neck, and back (upper and lower) - OK 20 months ago.

Current BP 126/81 (was 185/105 about 3 weeks ago. Went off Savella then)

 

Any direction you can provide would be helpful. Something is causing my muscles to be constantly firing, and that constant action seems to lead to constant pain and weakness. I can still walk, but get extremely winded walking from one end of the house to the other. I am always dizzy, always lightheaded, always feel like I have a lo-grade fever, and always ache. I have had 4 different rounds with physical therapy, and the last therapist said "you are weaker than my 85 year old osteopath patients. Something is really wrong with you and you need to keep searching until you find it out. Basically all my muscles are just severely fatigued, and I truly cannot exercise, and lose a little more strength each month. Savella aided barely with maybe 10% more energy and 10% less pain, but gave me high blood pressure like Pristiq did. Lyrica seemed to really heighten my peripheral neuropathy. Most doctors throw up their hands. I have not had a muscle biopsy nor a spinal tap. If you asked me, I have some sort of MS or Lupus, but maybe its time for a new MRI since I'm so much worse than 20 months ago when it was taken.

Thanks for your time!

Customer: replied 4 years ago.

Sorry. Yes, periods are regular, but have only been "two days" for the last few years. Also, I am a healthy weight (115 lbs), and have always been in shape. Used to exercise regularly before this hit in August 2008.

Expert:  Dr. Sophie :: Medicine & Neurology replied 4 years ago.

Hi again,

Are the fasciculations visible or do you just feel the twitches? Where are they exactly?

Did you have them when the EMG was being done? Did they test the paraspinal muscles with a needle across the mid-back from top to bottom?

Did they do repetitive stimulation (10+ times at the same site) in the the nerve portion of the EMG study? (you would remember that - pretty unpleasant)

Are you in the Bay area?





Customer: replied 4 years ago.

There is a sensation of very minor twitching, it's more like a buzzing or vibration, over all my muscles everywhere all the time. The visible twitches and fascinations only happen every so often. Probably for a total of 2 hours out of every 24, but they only last 5 seconds to maybe 5 minutes (some are very short and by the time I get a pant leg or shirt pulled up they have stopped other times they last off and on for up to 5 minutes. They occur all over my body, but most often on legs (top front or back of calves), upper arms, or anywhere across the upper back. They can also occur on my front side by my ribs, or in my hands, or almost anywhere. They have happened twice for maybe 15 seconds each on my back left side while typing this. None have ever been visible when seeing a doctor. Both EMGs were on my lower legs, included repetitive tests about 10 times, and no visible twitching occurred during that testing. They have never done an EMG on my back. Doctors really focused on my legs the first few months as my initial symptoms were an incredible weakness in my legs. Within 3 months the weakness, aches, fascinations and burning muscles were in my arms, neck and back too. It spread to my front side/chest maybe in the last 9 months. I live in the central valley by Fresno. I appreciate your time SO much!

Expert:  Dr. Sophie :: Medicine & Neurology replied 4 years ago.

You're welcome.

Fasciculations, as you probably already know, can be benign or pathological.
Benign ones - such as in people who are very active physically or work out a lot and occur without any other associated symptoms. Pathological ones usually occur in association with other neurological symptoms such as muscle fatigue, pain, weakness, etc.

If they occur as prequently as you described, they should have been picked up on EMG either spontaneously or after being elicited.

ANA is non-specific, i.e does not necessarily mean you have lupus, and can be positive in RA, scleroderma, autoimmune thyroid or liver disease and even mononucleosis.

There are lab studies (blood work) that should be done and perhaps some have been done already: anti-Sm, anti-RNP, anti-dsDNA, C3 and C4 levels. They should also check your Lyme titer, vitamin D level and CK/aldolase (muscle enzymes) levels and magnesium level (you may want to try supplementing your mag to see if this makes things better).

I think your neurologist should consider spinal tap to rule out central nervous system involvement and muscle biopsy. Myasthenia gravis, motor neuron disease and myopathy need to be ruled out. It would probably be better if you were referred to MDA clinic Forbes-Norris at California Pacific.

I hope this helps.

Dr. Sophie :: Medicine & Neurology, Doctor
Category: Medical
Satisfied Customers: 2951
Experience: Neurologist :: Clinical Neurophysiologist :: University of California.
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