What Causes Pain In Lower Legs And Severe Lethargy?

Posted on Tue, 14 Apr 2015

Question: I am having severe lethargy in body. Always feel tired, don't feel like working. Even when I get up in the morning after 8 hours of good sleep, feel like lying down. I have pain in lower legs below knee cant stand for more than 10 minutes. My body becomes stiff. I feel weak and depressed because of this. I am having good normal diet three times a day at home. This has been continuing for few years now. This is a kind of attack which comes anytime anyday and may go in a day or few days. I got all the tests done prescribed by doctor, they are okay. vit b12 was on lower side. I was prescribed meganeuron, maxneuron-lc, neurokind-lc, carnisure at different times. These medicines were effective but for a few days or months. Now again I am having same problems and these medicines are not effective. Can you suggest what to do?

Answered by Dr. Ravi Soni (3 hours later)

Brief Answer:
This has became psychological game now

Detailed Answer:
Hi, thanks for writing through HCM.

I have read your query and understood your concerns.

First of all, deficiency of vit. B12 can cause calf pain in lower limbs and it can also cause leg cramps at night or during sleep. Apart from this, you haven't mentioned regarding your vit.D level. Have you gone for that? If you have not gone for vit. D level testing then I suggest you to go for it because it can also be responsible for joint pains as well as pain in lower limbs. If the level will come low then you have to take supplement of both calcium and vit.D.

Do you eat non-veg? Eating only vegetarian diet will cause repeated vit. B12 deficiency. Sources of vit.B12 are meat, fish, poultry, eggs, and dairy products. You have to modify your diet. At least start eating eggs.

Chronic leg pain can be the cause for depression, while lethargy and fatigue are the symptoms of depression itself. So, considering the leg pain as the cause for depression, you need to correct the source of all these symptoms that is leg pain. Modifying your diet and eating healthy food rich in Vit.B12 will help. I suggest you to take supplements for calcium and Vit. D also.

Even after all these management if you won't improve then I shall suggest you to take antidepressant drugs after visiting a psychiatrist, that also helps in improving chronic leg pain like duloxetine or Amitryptilline. This we can consider afterwards.

Hope I have answered your query. If you have further query then I shall be happy to help.
Wish you good health.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ravi Soni (4 hours later)

Dear Doctor,

My vitamin D was as low as 11 two years back. I had been taking Dgain pouches since then. Recently I got it tested, it was 110. The range of lal path lab was 75-250. So now it is fine. Still every two weeks I take one pouch as advised by orthopaedic. There were joint pains earlier which have improved now. But lower legs pain below knee comes on & off still. I had taken calcium also but it created gastric problems, many different tablets tried. But my calcium level was within the range. Also I have chronic kidney stones (calcium, phosphorous, oxalates found in stone test) problem for past 25 years so cant take calcium. I have got BP high problem for which I take amtas 5 mg and it is under control 130/90. I cant eat non-veg since I don't like it, tried many times. I take dairy products like milk/curd/paneer once a day. I feel depressed when I have lethargy because I am not able to work normally, as such I am fine not depressed. I get depressed sometimes due to quarrels at home but then I recover. I have tried some antidepressents at times but then I feel very sleepy during day time also, so discontinued and I don't think I need them. Further I have erectile dysfunctioning (ED) problem also. So kindly suggest remedy for lethargy/fatigue and ED problems considering above mentioned status of my health. Also suggest veg diet to be taken by me. I hope I have clarified your points raised.

Thanks and regards,
XXXXXX
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Answered by Dr. Ravi Soni (6 hours later)

Brief Answer:
Antidepressants can be used to treat pain

Detailed Answer:
Hi, thanks for writing again.

It is god that your Vit. D level is within normal range now.

I have already told you about foods high in vit. B12. If you are not eating non-veg then you can eat dairy products and that you are doing already. So nothing else can be done.

Anti-depressants like duloxetine and amitryptilline are approved for neuropathic pain and other types of chronic pain. I have suggested Antidepressants to relieve pain not for depression. You can visit a neurologist and take his opinion because even after managing the pain with vitamin supplements, if it is still there then there are very few options available. You can also have pregabalin or gabapentin for pain. There are combinations available also like methylcobalamin and pregabalin or gabapentin+amitryptilline etc.

For lethargy and fatigue, I would have given to my patient modafinil or armodafinil, these are the drugs which have activating effects and removes the feeling of fatigue. Similarly activating antidepressant is bupropion which can also be tried.

You have to consult a psychiatrist to get a prescription for these drugs. Visit one and discuss your problems with him. He will guide you for further management.

Hoe I have answered your query. If you do not have further query then close the discussion and rate the answer.
Wish you good health.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj