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What Causes Tingling, Stabbing And Burning Sensations In Body?
Question: I am a 39 year old male with otherwise no health issues prior to this situation. 7 months ago, I started getting burning, stabbing, tingling sensations throughout my body. I have been to a few neurologists with a diagnosis of idiopathic small fiber neuropathy as confirmed by a skin punch biopsy (density very low). Other than that my workup including brain and cervical MRI's with and w/out contrast completely normal. I am now completely perplexed and the symptoms persist and are pretty impairing and have become even more painful and I have tingling in my scalp, eyes, and now have tinnitus. I am curious if as a neurologist, you have seen these cases and in what percentage of the time they are self limiting or if they never go away or get worse. I have 3 children and am the breadwinner so I am very nervous and losing hope. Life has been completely been put on hold.
Brief Answer:
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Detailed Answer:
I read your question carefully and I understand the distress you must be in. Neuropathies in general are very frustrating conditions at times resistant to treatment.
Since you have been to more than one neurologist and you have had extensive testing I am assuming the diagnosis has been proven. Also I assume correctable causes like diabetes, infections, paraneoplastic syndromes, celiac disease have been investigate and it is an idiopathic case (with no identifiable cause).
To answer your question, the course of the disease varies a lot from patient to patient, there are patients where the symptoms remain self limited to some paresthesias of the limbs, but there are also cases like yours which seems to be a pretty severe case where manifestations have already reached their peak. Often there is a cause which is identified and predictions depend on whether the cause can be removed. Unless there is a cause which can be treated though, unfortunately the symptoms are unlikely to go away, they do persist.
However with therapy improvement can be achieved in many patients. You seem to have tried only anticonvulsant class of drugs to control the symptoms. I think since they're ineffective a tricyclic antidepressants like amitriptyline should be used which are a first choice drug to treat this type of neuropathy (doesn't mean you're depressed, but they have effect in neuropathic symptoms apart from the originally known antidepressants effect). So I think it is an obvious step which should be discussed with your doctors.
I remain at your disposal for further questions.
Read below
Detailed Answer:
I read your question carefully and I understand the distress you must be in. Neuropathies in general are very frustrating conditions at times resistant to treatment.
Since you have been to more than one neurologist and you have had extensive testing I am assuming the diagnosis has been proven. Also I assume correctable causes like diabetes, infections, paraneoplastic syndromes, celiac disease have been investigate and it is an idiopathic case (with no identifiable cause).
To answer your question, the course of the disease varies a lot from patient to patient, there are patients where the symptoms remain self limited to some paresthesias of the limbs, but there are also cases like yours which seems to be a pretty severe case where manifestations have already reached their peak. Often there is a cause which is identified and predictions depend on whether the cause can be removed. Unless there is a cause which can be treated though, unfortunately the symptoms are unlikely to go away, they do persist.
However with therapy improvement can be achieved in many patients. You seem to have tried only anticonvulsant class of drugs to control the symptoms. I think since they're ineffective a tricyclic antidepressants like amitriptyline should be used which are a first choice drug to treat this type of neuropathy (doesn't mean you're depressed, but they have effect in neuropathic symptoms apart from the originally known antidepressants effect). So I think it is an obvious step which should be discussed with your doctors.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Taka. Yes - I have done the full panel. The immunologist was doing some more immunological testing to see if there are any markers that could point to success via IVIG but not optimistic. A few of the neurologists I went to had the belief that it was driven by an acute viral infection and that this is a post viral syndrome I am experiencing but that it could take up to 2 years to experience recovery as that is the time it could take for axonal nerve regrowth. The prospect of living with this forever is daunting so I was hoping for that to be a viable case but seems unlikely given how long and how severe the symptoms have been. Amitryptaline is a good idea. I tried Cymbalta which had horrible side effects which is why I have avoided the tricyclic's but may try amitriptyline in a bit. Thank you for your thoughts. Quite consistent in general with others. It was more this post viral syndrome theory I was trying to understand if you had seen.
Brief Answer:
Read below.
Detailed Answer:
Thank you for the additional information. I understand what you were hoping. I can not dismiss that hope, it is just that it is difficult to prove post viral hypotheses, I can't say to have had such patients. It is mentioned in the literature but there are no percentages on frequency or outcome, I suppose precisely because it is more of a hypothesis and it's hard to prove it in patients.
I sincerely hope you will get better soon.
Read below.
Detailed Answer:
Thank you for the additional information. I understand what you were hoping. I can not dismiss that hope, it is just that it is difficult to prove post viral hypotheses, I can't say to have had such patients. It is mentioned in the literature but there are no percentages on frequency or outcome, I suppose precisely because it is more of a hypothesis and it's hard to prove it in patients.
I sincerely hope you will get better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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