Ask a doctor on the topic of General medicine

Working diagnosis / Specialist sought - Leading symptom muscle pain

January 22, 2012 | 25,00 EUR | answered by Dr. med. Ralf Berg

Description

We are looking for a work diagnosis and/or suitable specialization for a young lady born in 1987, who unfortunately has not received any therapy so far (except symptomatic treatment). The limitations of quality of life, ability to work, and trust in medicine are decreasing significantly and continuously.

The focus is on severe muscle pain, which regularly leads to inability to work and bed rest. Numerous other complaints are noticeable:
- High tendency to (severe) muscle cramps - even in earlier times when active in competitive sports
- Spotting, despite a high dose of birth control pills
- Fluctuating appetite
- Various food intolerances
- Fatigue

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a) When did it first occur?
October 2009

b) When does it occur?
Occurs with temperature fluctuations in colder weather. Fall (around October) - Spring (around March)
In humid weather
Already in the summer of 2011, due to high humidity and inconsistent temperatures.

c) Symptoms?
- Pain in the muscles of the arms, legs, and hands since 2011.
- Muscle pain begins after consuming alcohol (not much, e.g. a glass of beer) in the thighs.
- After the typhoid vaccination in 2011, in addition to the pain, there was a feeling of stiffness in the arms and legs.
- Tendon pain, upper right foot near the ankle since summer 2010. In 2010 only in the summer when warm. In 2011 also in non-warm weather after about 10 minutes of stress.
- Stomach/intestinal cramps
- Feeling cold
- Food intolerances according to a naturopath. (Glutamate, wheat, egg yolk, egg white, pork, onion, garlic, citrus fruits, hazelnut, etc.)
- Fatigue, need for a lot of sleep but sleep disturbances (conscious waking up between 2 and 10 times a night)
- Weakness
- Hair loss
- Lack of concentration
- Frequent morning nausea

d) Pure rest/constant pain - or stress-related?
Pain occurs both at rest and during stress (worse).

e) Influence of cold/heat - preventive?
No complaints in warm temperatures.

f) Influence of cold/heat - therapeutic?
Heat and keeping still reduces it. As soon as the heat dissipates, it worsens again.

g) What diagnostic tests have been done so far?
Doctors: General practitioner, neurologist, rheumatologist, orthopedist
Blood tests, CT scan, nerve tests, thyroid examination, X-rays

h) What treatments have been done so far?
Pain-relieving injections, physiotherapy, heat treatment

i) Frequency of occurrence?
Occurs as soon as there are a few degrees of temperature difference.
2009: severe pain
2010: much less
2011: already milder "attacks" in the summer,
September

Dr. med. Ralf Berg

Dear family members/parents,

I assume that you have been authorized by the patient to act on their behalf in this matter and to present their medical history here. Assuming that all necessary tests by specialists (CK?, ANCA? RF? Muscle biopsy?) have been performed and were inconclusive, ruling out anemia, hypothyroidism, collagenosis, rheumatic muscle diseases, I must consider the possibility that there may be a psychosomatic disorder, a masked depression, or a neurotic cause underlying the multiple complaints.

I understand that you may expect to be referred to another specialist in muscle diseases, but regarding your question: working hypotheses and choice of specialist groups, I must honestly inform you that the field of psychiatry/psychology has not yet been considered. Your detailed description provides some indications that strongly suggest a psychological cause, or at least a psychological component (aggravation).

Therefore, I would advise you to consider having the patient also consult with this specialty. Whether this should be done in an outpatient setting or preferably (briefly) in a hospital setting should be decided by the respective psychologist/psychiatrist. It is important that the patient herself describes her experiences and symptoms, as well as making the existing test results and findings available for review.

I share your view that further therapy is necessary due to the severity of the symptoms. This includes social and biographical history, as well as information related to personal privacy. This cannot be conducted online.

I hope you can motivate the patient to undergo psychiatric and psychological examinations promptly.

Best regards,
Dr. R. Berg