Nociceptive Pain
 

Because I'm stuck off my feet most of the day, and don't have much else to do besides try and find a way to cope with my situation, I recently began looking more and more into nociceptive pain. This is just me thinking out loud and seeing if anyone can chime in with help.

I used the search function and didn't find a whole lot of information on nonciceptive pain. I've always wondered why not very many people mentioned achy pain when referring to PN. Don't get me wrong, I get the burning, freezing, stabbing, stinging pain that everyone else refers to. I also get this deep ache in my heels, arches, and ankles. I know, I'm so lucky to get a taste of all the possible types of pain associated with PN! :rolleyes:

I think I get a little relief from burning and stabbing with Nortiprtyline and Gabapentin, but it has never helped my achy pain. Come to find out the achy pain is more of a nociceptive pain. The deep ache usually only affects me when I'm on my feet and is mechanical in nature, but boy does it hurt. Truth be told it bothers me more than most of the other pain. It is literally the main reason why I have to stay off my feet. Sounds like it is probably my nerves reacting to the damaged nerves and telling me to sit down. It is non traumatic in nature, as I haven't had any injuries that can explain it.

It makes me think I'm going to have to try and explain my situation to my neurologist in an attempt to better find a medication to help me function. I already know the resistance to getting opiates and I understand. I can imagine how well asking for them would go over. :cool: Anybody with similar symptoms find relief from any medication in particular? NSAIDS do nothing unfortunately, but it sounds like people have had luck with Tramadol.

I'm still holding out hope for healing to get me to a livable pain level. I guess in the mean time I just sit here with my feet up dreaming of a medication which would allow me to be on my feet more than 10 minutes at a time. It's really a depressing situation to be in, but I'm sure I don't have to explain that to most of you here.

We had a fellow here in the recent past with severe foot pain...and it turned out he had psoriatic arthritis.

http://www.mayoclinic.org/diseases-c...s/con-20015006

It is something to think about as a cause.

I have a similar situation to you, but possibly reversed. I get the achy pain but it's on the bottom of my pain order.

Lyrica takes care of about 90% of the electric shock pain.
Tramadol takes care of about 75% of stinging, burning.
Nothing touches the achy pain though.

Stinging, burning pain is worse at night.
Achy pain is worse in the mornings, or getting up after sitting.

My GP thinks the aches may be Plantar Fasciitis, or heal spurs.

For the most part, I can be on my feet about an hour at a time, long enough to do a class (I teach 1hr classes a few times a day). Some days are worse than others though, but I'm not bed ridden, yet. I have no doubt whatsoever that if I didn't take the medications I would be unable to function at all.

I am certain others here will be of much more help. But, wanted to put in my situation in case it sounds like you. :)

Edit: forgot to mention, the way I get through the heel aching pain during times when I have to drive, walk, etc. I wear Burkenstock shoes, they are designed to support the arch. I find with good arch support I can stand for much longer than without.

I really only get the achy pain when bearing weight. Just like my other PN symptoms it came on very acutely and unexpectedly. I've considered everything including arthritis and plantar fasciitis but believe it is directly related to PN in some way. I've given up trying to figure out what is causing it for now and am just focused on relief as all the doctors so far haven't really pointed me towards a realistic diagnosis.

I think best case scenario is it is some acute injury to some soft tissue, joint, and or nerve that can heal with time. I'd say I'm 10% better than I was 3 months ago when it started, so I guess there's hope for improvement. I could probably function on 50% relief. It's so hard to find anyone with similar pain/symptoms to bounce ideas off. although the "golf ball" walkers might be my best bet, as that's what I'd compare it to today.

On my best days I'm still 3-4 pain walking around for short distances and think to myself "I feel great!" Never thought I'd be happy to live with a constant 3-4 pain :rolleyes:

Further on the Mayo link are these diagnostic tests:

http://www.mayoclinic.org/diseases-c...s/con-20015006

This condition may present initially in the feet, so it would be wise to consider it.

"No single test can confirm a diagnosis of psoriatic arthritis. But some types of tests can rule out other causes of joint pain, such as rheumatoid arthritis or gout."

Here's my problem with psoriatic arthritis. It's more of a catch all for "we don't really know what's wrong with you so we'll call it psoriatic arthritis." I guess that applies to a lot of medical diagnoses.

I already had a heated argument with a podiatrist who wanted to call it plantar fasciitis. I told him just because I have pain on the sole of my foot when standing doesn't mean it has anything to do with my fascia. This was before I had a long list of obvious neuropathic symptoms, so it was hard to convince him otherwise.

I guess when you know your body and study the symptoms associated with the differential diagnosis involving injury and disease processes, it's not difficult to rule things out on your own. (Thank you internet) Maybe I'm just being narrow minded, but I knew I had PN before I was diagnosed by a doctor, I just needed confirmation to obtain medication, look for the cause, and cope with the pain.

I'm grateful for the hypothesis mrs D, as there aren't many people willing to provide such thoughtful insight on there own time. I still believe there is another cause at work. If it turns you were right, I will humbly mail you a bottle of your favorite beverage as a token of gratitude. ;)

Your presentation includes a rapid onset? After a vaccine?
Psoriatic arthritis is an autoimmune type condition and those tend to appear suddenly when there is an immune trigger.
Autoimmune conditions tend to run in families, with certain genetic tendencies to be reactive with the immune system.

I'd refrain from using the word nociception with your doctor.
They tend to label people in the records as hypochondriacal when medical terms like this are used in conversation. Just focus on your lost quality of life, symptoms, etc. Also it is a good idea to LOOK ill... this factor is more common in women who will dress up and wear makeup to the doctor's office. If you have serious pain and issues, you should look like you do..and not get all fixey. Doctors make decisions within seconds of your walking thru the door. My doctor once greeted me with "are your eyes always this puffy?", before even saying hello once.
(now we know I am puffy because of angioedema...but since that is quite rare, puffy could mean something else for someone else). That is just one example.

I get terrible achey pain in my arms I describe it as being like tooth ache, it is horrible, nothing seems to help with it :/

I have recently started to experience terrible achy pain in my legs and feet and sometimes in my arms and back. These symptoms also came on suddenly I am now wondering if this is related to a change in the weather. Spring has finally arrived here along with all the pollen etc. Could this be a immune system response to spring allergens?

Thank-you for the tips on doctors office visits mrsD. I have one tomorrow with my neurologist. Feeling the way that I have lately, I do not think I will have to worry about looking too fixed up though.

I would caution not to go too far the other way, either—don't "put on a show". Doctors are pretty good at reading people, and if they suspect deception/exaggeration, you could also get labelled (in the extreme) malingering, "drug-seeking", "Münchausen Syndrome", somatic symptom disorder, etc.

patient exaggerating symptoms

IMO, your appearance should reflect how you actually feel—no more—no less.

Doc

Keep in mind... there is NO 100% accurate diagnostic test for most things. So reading about the psoriatic arthritis, is just a typical description for most problems. Many people with rheumatoid arthritis, never test positive for Rh factor.

Lupus patients may have periods of normal ANA tests. Those are just 2 examples.

Not really. Acetaminophen takes the edge off if/when I'm just sitting around. I take amitriptyline at night (as needed), but I'm not really sure if/that it alleviates the pain (it doesn't do much/anything if I don't go straight to sleep) or just knocks me out. Massage feels good, but doesn't really make anything go away. I can't take NSAIDs; I wish that I could.

I don't know about cannabinoids, as they're not yet legal where I am.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430692/

Mild exercise seems to help a little—getting the blood/circulation moving, but too much/too intense exacerbates things.

Doc

I began seeing a psychiatrist not long after the onset of my pain. I made it pretty clear that I had never had an issue with depression before and was only depressed because of my pain and decreased quality of life. I told her if the pain ever went away she would never see me again. Its a good walk from my car to her office so I brought crutches last time. I wonder what she thought of that.

Also I went in flip flops to my first neuro appointment in 50 degree weather and made it clear I couldn't tolerate shoes or socks. I've never asked for pain medication other than gabapentin. I'm not sure how long I can hold out with the pain before I start making suggestions.

In my case
 

any doctor I see has only "heard" about CMT. They have had like 10 minutes on the subject. So unless I see a neurologist who knows CMT, which I have, the other doctors have no clue. Even the orthotist and the podiatrist have seen only two others and we are all different. They seem surprised since they cannot put us three (don't know the others) into one category. That's how much they really know.

Thanks, I try and refrain from sounding like a "know it all"

I do work in the medical field so I tend to use medical terminology when appropriate, and my doctors are aware of my profession so I hope they don't think I'm trying speak "over my head"

I've also done a lot of research and learned so much here on this board about my condition, so I feel like walking a fine line when speaking with my doctors and letting them in on how much I know.

So when they go in to their "neuropathy talk" and I know what they are going to say before the words come out of their mouth, most of the time I just sit there and nod my head and act like I'm learning something new.

One thing that is frustrating is, if I now know that "achy pain" isn't something helped my TCA's and Antieleptics, shouldn't the neurologist know this? If I know of dozens of tests for neuropathy causes shouldn't the doctors? I'm still learning to dance with the doctors to get proper treatment, but it's a process.

Is it common for arthritis and PN to go hand and hand? My right foot hit me hard with aching, burning, and sensitivity all within 24 hours and all in the absence of injury or illness that I'm aware of. Seems that there has to be a logical explanation, I just haven't found it yet.

Fast=
1) autoimmune attack (including arthritis and tendonitis)
2) poisons (sudden high doses heavy metals) or pesticides/herbicides
3) gout (uric acid or pseudogout with calcium crystals)
4) vaccine injury (but these are autoimmune in symptoms)

In my experience PN itself, is slower in onset.
Secondary causes like diabetes, hypothyroid, are slower onset.

There are about 100 causes of neuropathies.

I worked as a health claims adjuster a number of years ago so I knew a lot about different conditions. And also, as far as CMT, I've done reputable research on that since snail mail. Many, many years and it has been in my family forever.

I get that achy pain in my legs and ankles too, I don't know what it is either. It seems to me like the sural nerve is irritated but I feel it in my muscle too as a 'nervy' kind of pain. A lot of mine seems to be med side effect from COPD meds.

judi

You're not alone. I've been taking notice of other peoples' footwear (or lack thereof) in public, and canes/crutches/sticks, and I think I'm starting to be able to identify other PNers. If you regularly/semi-regularly bring crutches with you and wear flip-flops whenever you go out, I wouldn't worry about it. I've been wearing slippers and using a cane for a few years now. Once a doctor asked me if I needed the cane, and I told him, "Only if I don't want to fall down." End of discussion. No one has ever asked about the slippers, but one look at my edema-swollen feet should answer that.

Rather than making suggestions, some chronic pain wisdom is to ask for suggestions on how to deal with pain, and/or as MrsD suggests, focus on symptoms and the effect they are having on your day-to-day life.

I've used some technical terms with my doctors, but I've always told them upfront that I'm very proactive, and they find out very quickly that I'm not their "average" patient. I find that doctors are more open to my ideas when I'm open to/willing to try their ideas/suggestions. I ask questions and their opinions, but I don't try to Dx or Rx. If something is/isn't working, I'm not shy about giving feedback.

Doc

I agree with both opinions here.

I think we often try to mask our health to the general public. Call it a survival mechanism perhaps, but we try to avoid looking weak. For women this is much easier as we can use makeup and a variety of tricks to mask our appearance.

My interpretation of what Mrs D is saying here is, present the 'real' you to the Doctor, not you hidden under layers of makeup and brave smiles. Present to the Doctor in a clean, tidy, honest way. Show him the person who your family sees. Not the person reserved for public appearances. Pretty sure that's the point, or thereabouts. :)

Feeling Achy