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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35741
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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M suffering with pain and coldness in legs from the last 6

Customer Question

Hi m suffering with pain and coldness in legs from the last 6 months . Had done many test but non of the doctors knows what is this ? Please help me its in bearable .
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.


I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Could you please tell about the investigations done and specialist consulted?

What are the treatment tried?

Are you on any medications?

Do you smoke?

Any significant past medical history?

Expert:  Dr. Arun Phophalia replied 2 years ago.

What did your electrophysiolgical studies and biopsy show?

Expert:  Dr. Arun Phophalia replied 2 years ago.


I am writing you an initial answer. We can discuss it further once you review this. The commonest cause for pain and coldness in legs are;

1) Nerve disease (termed neuropathy)

2) Arterial diseases; This is investigated by colored doppler study, arteriography and arterial biopsy.

Following are the causes of neuropathy (many times cause is not known);

1) Diabetes

2) An underactive thyroid gland

3) Excessive use of alcohol

4) Thiamine deficiency

5) Vitamin B 12 deficiency (pernicious anemia)

6) Vitamin B 6 (pyridoxine) taken in excessive amounts

7) Drugs, medications, herbs

8) Autoimmune diseases

9) Heavy metals such as lead and mercury.

Following investigations are done (many of which had been done for you);

1) Electromyography/nerve conduction studies (EMG/NCS)

2) MRI of the spine and brain

3) blood glucose and glycosylated hemoglobin

4) serum B12 level with methylmalonic acid (with or without homocysteine),

5) serum protein electrophoresis

6) Anti-nuclear antibody

7) Lyme testing

8) Rheumatoid factor

9) Sjogren's syndrome testing (Anti-Ro, Anti-La Antibodies)

Skin and nerve biopsy are recommended after the results of these investigations.

This should give the diagnosis and guidelines for the management.

Supplements and alternative integrative therapy protocols for neuropathy are;

1) Evening primrose oil

2) Acetyl-l-carnitine

3) Alpha-lipoic acid

4) Benfotiamine (Milgamma), 100 mg, is a lipid-soluble vitamin B1 analogue

5) Vitamin E

Your physician may consider to start Gabapentin or Pregabalin, if symptoms are significant and persistent.

Investigations to ascertain the nutritional neuropathy are;

Thiamine (vitamin B 1 ) deficiency: A serum thiamine (vitamin B 1 ) level

Pyridoxine (vitamin B 6 ) level

Folate deficiency: Serum folate levels .

Niacin (vitamin B 3 ) deficiency: Urinary excretion of N -methylnicotinamide

Cyanocobalamin (vitamin B 12 ) level

Pantothenic acid deficiency: Excretion is less than 1 mg/d.

Alpha-tocopherol (vitamin E) deficiency: The serum α -tocopherol (vitamin E) level

Hypophosphatemia: Serum phosphate level

Biotinidase levels

There are metabolic causes of neuropathies too and following investigations may help in diagnosing them;

Aminolevulinic acid synthase in urine (porphyria)

Arylsulfatase A and B (leukodystrophies)


Urine oxalate levels

Serum lactate, ammonia, and pyruvate

Urine myoglobin

Muscle histochemistry

Enzyme assays of muscle, blood, and fibroblast

Leukocyte glycogen levels to detect acid maltase deficiency

Leukocyte, DNA analyses (McArdle disease)

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 2 years ago.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.