What are the treatments for chronic, unbearable leg pain? – BillDoll.com Billion Dollar Questions @ BillDoll - The Billion Dollar Site

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What are the treatments for chronic, unbearable leg pain? .. .. Getting Out of Leg Pain – a To-do eBook Step-by-step suggestions to get out of your terrible pain I started the Billion Dollar Site (actually started it as the Billion Dollar Questions Site) to find an answer to this question because my mother suffers from chronic, unbearable leg pain, mostly in the nights. We had seen any number of doctors, but to no avail. On doing a bit of research, I figured there are lots of people around the world, especially women over 50 years, who have chronic leg pain. The reasons behind their pain might or might not be the same as my mom’s, but I felt it could be useful if I aggregated and presented in one place whatever material I collected during the research I did for my mother. This could make it easier for people to check out possible cures/treatments. I’d be grateful if you could provide your feedback and any other suggestions/links/resources you have for this page. Your inputs may be kindly sent to: ecacofonix@yahoo.com As for my mother’s leg pain, at last there appears to be some light at the end of the tunnel – after a good number of tests and trials (four doctors in all, three different specialties – vascular, ortho & neurologist), a neurologist has diagnosed her problem as Restless Leg Syndrome with perhaps some fibromyalgia as well. We are not yet 100% certain about this, but she seems to be responding quite well to medications that treat fibromyalgia and RLS. It’s early days and I’m keeping my fingers crossed, but she has been having excellent relief to these medications last few months. I will try to provide as many resources and links to many more in the context of leg pain – especially chronic and severe leg pain. Most of these were collected while doing some part-time research on these pain areas. I will also try to provide some of my personal opinions and thoughts on the process of getting rid of leg pain, based on the interactions I have had with doctors and other patients I met during my visits with my mom, as well as based on the observations of the processes and methodologies that the various doctors undertook during different stages of her treatment. The key objective of this section is to help you classify type of leg pain you are suffering from, and the type of doctor/s you should visit to start off the diagnosis and subsequent treatments. I’m hoping that my researches and resource aggregation will be useful at least a few others who are suffering from leg pain. This page is a work in progress, and I will continue adding (hopefully) useful content. Disclaimer: I’m not a qualified doctor, and all inputs provided at this page are what I have collected from around the web my research for my mother, and my observations of doctors’ methods. I’d request you to treat the contents of this page in this light, and always consult a qualified professional before undertaking any medical efforts. Some health related questions @ BillDoll that could be of interest to you: (For the complete list of questions we are trying to answer at Billion Dollar Questions, please see BillDoll Home Page ) How can graying of hair be reversed? What are the cures & treatments for insomnia? What are the main cares that should be taken during pregnancy? What are the best treatments for atherosclerosis/arteriosclerosis - clogged heart arteries? What is the best cure for obesity? What are the best foods to maintain a healthy body? What are the regular exercises to maintain a healthy heart? How can I overcome depression & frustration? Popular Searches related to Leg Pain – the following are some of the most frequent searches done for leg pain related conditions. Click on the link next to the search term for a search on Google Leg Pain >>> Leg Pain And Numbness >>> Cause Of Leg Pain >>> Lower Leg Pain >>> Pain In Leg >>> Back And Leg Pain >>> Muscle Pain Lower Leg >>> Leg Muscle Pain >>> Upper Leg Pain >>> Hip And Leg Pain >>> Lower Back And Leg Pain >>> Leg And Foot Pain >>> Sciatica Leg Pain >>> Leg Pain In Child >>> Cause Of One Leg Pain >>> Night Leg Pain >>> Child Leg Pain >>> Chronic Leg Pain >>> See also: Know Everything Online about Leg Pain – see at a click of the mouse all the latest updates online about leg pain – from News search engines, blogs, message boards, books, groups, articles, bookmarking sites, shopping… Related sections @ BillDoll: A-Z of Diseases – diagnosis & treatment resources for over 200 diseases @ BillDoll Diseases section; click on the letter for diseases starting with that letter: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z Chronic, Unbearable Leg Pain Sections at this page Diagnosis, Diagnosis, Diagnosis! Leg Pain Classifications, Symptoms & Doctors – this is the most important section, where I have tried to point out the various symptoms for each type of leg pain and the corresponding doctor to be consulted. This section should help you in arriving at a quick short-list of the doctors you need to check with Choosing the Doctor/s to Visit What if the pain does not go away even after you visited a few doctors? Causes for Leg Pain Suggestions for Various Leg Pain Related Problems Breakthroughs & Medical Inventions for the Treatment of Leg Pain Some Notes Based on Observations & What I Read Elsewhere Links & References for Chronic Leg Pain See also the following topics under Leg Pain Peripheral Vascular Disease – PVD Peripheral Artery Disease – PAD Reflex Sympathetic Dystrophy Syndrome, RSDS Fibromyalgia Peripheral Neuropathy Restless Leg Syndrome RLS Venous Insufficiency or Varicose Veins Arterial Occlusion / Embolism / Clot Vein Thrombosis, Thrombophlebitis – DVT & SVT Arthritis Degenerative Joint Disease Diabetes & Leg Pain Sciatica Hip Pain Degenerative Disk Disease Spinal Stenosis Osteo sarcoma Section 1 – Diagnosis, Diagnosis, Diagnosis It sounds silly now, but for years we (me & parents) had blindly followed what anyone and everyone (not doctors!) said were the treatments for my mother’s leg pain. Sure, we kept visiting doctors, but most of these doctors were recommended by non doctors (usually well-meaning but not so well-informed family members & friends). I doubt if many others had been as ignorant as we had had been for so long, but it is possible that some of you are following certain procedures or visiting some doctors because a friend of yours (who is not a qualified medical professional) recommended them. If the causes of your leg pain have not yet been diagnosed, please spend enough time meeting good doctors – at least 4-5 of them in various specialties such as vascular, neurology, musculoskeletal, ortho/bone & joints, etc. Please remember that in the beginning this is somewhat of a trial and error process. You might have to visit 3-4 doctors before one of them is able to diagnose something positive. (the list of symptoms provided in this page could enable you to arrive at a small list of 2 to 3 types of doctors). The main point I’d like to make is – kindly don’t follow old wives’ tales, your non-doctor friends’ recommendations, and non-professional medications. Ninety-nine out of hundred cases, these won’t work and you will be wasting your time. We wasted 25 years trying all these before deciding to invest a few months in visiting doctors of specific specialties instead of general practitioners and assorted medical professionals, and it appears to be getting us somewhere close to a solution. The good doctors we visited spent time in doing a number of tests on my mother, and were willing to admit that they might not know the answer but that some other doctor of a different specialty could. The not-so-good doctors usually did not listen much to what my mother told them and classified my mother’s illness as something of a casual nature. Had they listened carefully (and given what my mother said some thought) they would have realized that her pain was severe, unbearable and chronic, not something that every woman over 50 years of age gets! I’d request you to recall a statement from the Zen Philosophy – It is important to spend enough time sharpening your axe before starting to cut down a tree. Diagnosis is, I’d think in my humble opinion, the most important part of treatment of any disease. You don’t need to be a doctor to figure that. I’d request you to spend time doing that, instead of wasting time and money on undiagnosed solutions. For those who are curious: We have been able to successfully (at least so it appears right now) diagnose my mother’s problem as RLS (restless leg syndrome), a nerve-related illness. I understand that there is no permanent medical cure right now, but she has been able to get excellent relief from the pain for the past 3 months she had been taking the medications for RLS. Fingers crossed… .. .. Sections 2 - Leg Pain Categories, Classifications What I plan to do in this section is to provide a list of symptoms to each and every one of the leg pain types mentioned here. This is done in order to facilitate your identifying your symptoms with those mentioned. Of course, only a qualified doctor can confirm what you are suffering from, but it is hoped that the list of symptoms would help you in deciding what types of doctors to go to. I have also provided some inputs on what types of doctors could help best for each type of leg pain. I consider this section to be the most important, and hence would provide as much attention as possible, because as pointed out earlier, a disease properly diagnosed is half cured. You are requested to pay special attention to the symptoms mentioned and the type of doctor suggested in order that you could decide what specialty doctor you could approach to begin with. The following are the classifications of leg pain. Your leg pain is likely to belong to a category or a combination of the categories below. Some of the categories mentioned below might not be of the chronic leg pain variety, while most others do belong to the chronic and severe leg pain category. The main categories discussed are: (the more important ones in the context of chronic leg pain are in bold) Vascular Neuropathic Musculoskeletal Metabolic Referred Neoplastic Traumatic Infectious Mechanical Leg Pain Vascular Leg Pain ***** – Vascular leg pain is caused by problems in blood vessels. This is one category where you might want to spend some time, because the types of diseases discussed here are the cause of leg pain in a significant percentage of people. The five stars denote that this is an important category for those suffering from chronic, severe leg pain! Type of doctor suggested: Vascular Specialists, Vascular Surgeons Venous insufficiency or statis, including varicose veins (see Varicose Veins @ BillDoll) - Varicose veins are abnormally swollen and twisted veins. Varicose veins are usually situated quite near the surface and are often visible beneath the skin.  Varicose veins can vary in size from quite small (a couple of mm across) to very large (2-3cms across). Symptoms - Often varicose veins will cause no symptoms at all and will merely be a nuisance because of their unpleasant appearance. Sometimes, varicose veins can cause heaviness or tension in the legs. There is often a feeling of swelling, aching, restless legs, cramps and itching. Symptoms such as these are often worse after a long day of standing. Symptoms are often worse in hot weather or after exercise and many women find symptoms are worse during their periods. If you have veins that are quite twisted and stand out in appearance, it is likely that your pain is due to the varicose veins. However, please note that many of us have varicose veins to a small degree, and these minor varicose veins usually are not harmful. In most cases, varicose veins are the reason where they are present in plenty and really stand out with their unpleasant appearance. Links for Varicose Veins: Chronic Venous Insufficiency (CVI) – Vascular Web, CVI Info from eMedicine, Venous Insufficiency – from Health A-Z, Varicose Veins – Symptoms, Tests & Treatments Arterial occlusion or embolism (see also: Arterial Occlusion @ BillDoll)- Arterial embolism is a sudden interruption of blood flow to an organ or body part due to a clot (embolus). Other forms of arterial occlusion are variously called peripheral vascular disease or peripheral arterial disease, in which cases the blood flow interruption is mainly due to plaque build-up. When the plaque build-up happens in arteries near the heart, it is called coronary artery disease, popularly known as atherosclerosis. When an embolism/clot happens in the lung it is called pulmonary embolism. In all these cases, the result is the interruption of blood flow owing to a clot or plaque. Symptoms Muscle pain in the affected area Muscle spasm in the affected area Numbness and tingling in the arm or leg Pale color of arm or leg Decreased or absent pulse in the extremity Cold arm or leg Lack of movement of the extremity Weakness of arm or leg Fingers or hands feels cool Loss of muscle function Decreased hair growth on the legs and feet Discoloration of the affected leg or foot when dangling (from pale to bluish-red) Temperature difference in affected leg or foot (cooler than other extremity) Presence of non-healing wound on affected lower extremity Shrinking of calf muscles Presence of thickened toenails Development of gangrene Later symptoms Blisters Skin erosion (ulcer) Tissue death (necrosis; skin is dark and damaged) Sloughing of skin Links for Arterial Occlusion: Scientific Description of Peripheral Arterial Occlusive Disease, see also: Peripheral Vascular Disease, Peripheral Arterial Disease, Intermittent Claudication ( see Intermittent Claudication page), Peripheral Artery Disease & Intermittent Claudication Diagnosis, Peripheral Arterial Disease – Symptoms – WebMD, Arteriosclerosis of the Extremities - NIH, Peripheral Vascular Disease – Comprehensive Info @ eMedicineHealth, PAD & Claudication – Vascular Web) A pic of shin splints Vein Thrombosis or Thrombophlebitis (see also Vein Thrombosis @ BillDoll) Superficial Vein Thrombosis - With superficial thrombophlebitis, the clot is in a vein just below the surface of the skin. Symptoms of SVT Skin redness or inflammation along a superficial vein Warmth of tissue around a superficial vein Tenderness or pain along a superficial vein (worse when pressure is applied) Limb pain Hardening of a superficial vein (induration) – in this case, the vein feels cord-like SVT Links – Superficial Thrombophlebitis – from Drugs.com Deep Vein Thrombosis - Veins are blood vessels that return blood from the tissues of the body back to the heart. The body has two distinct systems of veins, a superficial system and a deep system. The deep vein system is comprised of veins within the muscles of the body. A DVT is a condition wherein a blood clot (thrombus) forms in a vein of the deep system. DVT more serious than superficial vein thrombophlebitis because this affects the veins deep in the leg musculature that carry 90% of the venous outflow from the leg. It is important to get treatment for DVT at the earliest since later on the clot could proceed to the lungs and you have a pulmonary embolism, which is more life-threatening. Symptoms of DVT - Because deep vein thrombosis usually causes little inflammation, pain and redness of the skin over the vein are usually minimal. A significant percentage of the people with deep vein thrombosis have no symptoms at all. In these people, chest pain caused by pulmonary embolism (blood clot in the lungs) may be the first indication that something is wrong. When deep vein thrombosis blocks blood flow in a large leg vein, the calf swells and may be painful, tender to the touch, and warm. The ankle, foot, or thigh may also swell, depending on which veins are involved. The healing of some thrombi by being converted to scar tissue may damage the valves in the veins. Because the damaged valves prevent the veins from functioning normally, fluid accumulates (a condition called edema) and the ankle swells. The edema can extend up the leg and even affect the thigh if the blockage is high enough in the vein. Edema is worse toward the end of the day. Overnight, edema subsides because the veins empty well when the legs are horizontal. DVT Links - DVT Info from HealthSquare, DVT & Pulmonary Embolism Page from MedicineNet, DVT & Thrombophlebitis Details from eMedicine, DVT Symptoms & Diagnosis, Deep Vein Thrombosis Central (DVT Symptoms) Neuropathic Leg Pain ***** - Neuropathic leg pain is a complex, chronic pain state that usually is accompanied by tissue injury. With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured. These damaged nerve fibers send incorrect signals to other pain centers. The impact of nerve fiber injury includes a change in nerve function both at the site of injury and areas around the injury. Neuropathic pain can occur in any part of the body. The five stars denote that this is an important category for those suffering from chronic, severe leg pain! Type of doctor suggested: Neurologist Some common causes of neuropathic pain Alcoholism Amputation Back, leg, and hip problems Chemotherapy Diabetes Facial nerve problems HIV infection or AIDS Multiple sclerosis Shingles Spine surgery Symptoms may include: Shooting Pain Burning pain Tingling Numbness Among the many neuropathic pain conditions, the ones relevant to be mentioned here are: Diabetic neuropathy (See Diabetic Leg Pain @ BillDoll)- this results from nerve damage secondary to vascular problems that occur with diabetes Reflex sympathetic dystrophy syndrome (see also: RSDS @ BillDoll)– this disease normally follows an injury. This is accompanied by burning pain and hypersensitivity to temperature. Often triggered by trauma or nerve damage, RSDS causes the skin of the affected area to become characteristically shiny. Nerve entrapment – meralgia paresthetica – Meralgia Paresthetica – from eMedicine Peripheral neuropathy – Peripheral Neuropathy @ BillDoll, Peripheral Neuropathy Info Page – from NIH, Peripheral Neuropathy Info – from All Refer, Peripheral Neuropathy – from Cleveland Clinic, Peripheral Neuropathy Symptoms Links: Neuropathic Pain Causes, Symptoms, Diagnoses & Treatments on Medicine Net, Pain Syndromes – Neuropathic Pain through Vascular Disease Musculoskeletal Symptoms: It is difficult to mention one set of symptoms for illnesses belonging to this category, so symptoms mentioned along side each Type of doctor suggested: Primary care physician. He/she will suggest an appropriate specialist. Arthritis***** – (see also Arthritis @ BillDoll) There are over a 100 different types of arthritis, the most common among these being: Osteoarthritis Arthritis(also called degenerative arthritis or degenerative joint disease (DJD)), Rheumatoid Arthritis, Gout Arthritis, Ankylosing Spondylitis Arthritis, Juvenile Arthritis, Psoriatic Arthritis, Systemic Lupus Erythematosus (SLE) The five stars denote that this (arthritis) is an important category for those suffering from chronic, severe leg pain. Arthritis Symptoms – While specific symptoms could differ depending on the type of arthritis, most times symptoms would be extreme joint pain. The other symptoms could be one or more of the following: Sudden, severe joint pain Stiffness and/or swelling in the joints - especially shoulders, knees, and ankles shiny red or purple skin around the joint Extreme tenderness in the joint area - some times the area may be so tender that even the touch of a bed sheet may cause severe pain Loss of movement Snapping of the joints Bony growths at the joints and abnormal angulation Appearance of small bumps under the skin near the affected joints Low-back pain that is worse at night, in the morning, or after inactivity Stiffness and limited motion in the low back Hip pain and stiffness Limited expansion of the chest Limited range of motion, especially involving spine and hips Neck pain Heel pain Chronic stooping to relieve symptoms Chronic Fatigue See this useful page on Arthritis Symptoms that provides a list of symptoms for the most common arthritis types Rheumatoid Arthritis Medical Info – Medicine Net Other Musculoskeletal Illnesses  Muscle cramp – Muscle Cramps Info from Medicine Net, not chronic Muscle Strain - not chronic Ligament Strain - not chronic Over-exertion or Injury - not chronic Medial tibial stress syndrome (commonly called shin splints) - not chronic Stress fractures - not chronic Compartment syndrome Patellofemoral syndrome – Review & Guidelines for Treatment – American Family Physician, Chondromalacia Patella – from Medicine Net Degenerative joint disease – see Degenerative Joint Disease @ BillDoll Metabolic Disorders A metabolic disorder is a medical disorder which affects the production of energy within individual human (or animal) cells. Most metabolic disorders are genetic, though a few are "acquired" as a result of diet, toxins, infections, etc. Many times, metabolic disorders/diseases can result in leg pain. A classic example is that of diabetes patients, many of whom suffer from leg pain. · Diabetes***** - (see also Diabetes & Leg Pain @ BillDoll) Diabetes can result in hardening of the arteries thus resulting in the peripheral arterial disease discussed under Vascular. See the symptoms under Arterial Occlusion / Embolism · The five stars indicate that diabetes is a prominent reason for chronic leg pain · Type of Doctor to Visit for Diabetes: Endocrinologist  Symptoms of Diabetes Frequent urination Excessive thirst Extreme hunger Unusual weight loss Increased fatigue Irritability Blurry vision · Gout - Gout Info from Podiatry Channel · Phenylketonuria (PKU) · Metabolic syndrome · Sodium metabolism disorders · Calcium metabolism disorders · Hypercalcemia · Hypocalcemia · Potassium metabolism disorders · Hyperkalemia · Hypokalemia - Hypokalemia – from Wikipedia · Phosphate metabolism disorders · Magnesium metabolism disorders · Acid-Base metabolism disorders Referred Leg Pain Sciatica***** (see Sciatica @ BillDoll) The five stars denote that this (sciatica) is an important category for those suffering from chronic, severe leg pain, usually thigh and above, and lower back. Type of doctor suggested: Neurologist Symptoms: The pain of sciatica usually occurs in the back of your buttock and travels down the back part of your thigh. Sciatica very rarely travels past your knee and does not cause weakness to your thigh, leg or foot. Hip pain – (see Hip Pain @ BillDoll) Hip-related pain is always felt directly over the hip, or in the middle of your thigh. The pain you feel in the hip may in fact reflect a problem in your back, rather than your hip itself. Type of doctor to consult: A vascular surgeon might be a good starting point. If he is not able to diagnose anything, he will be in a good position to suggest someone else who can. Symptoms: Pain is always felt directly over the hip, or in the middle of your thigh Two common and concerning causes of hip pain are fractures and insufficient blood flow to the hip (aseptic necrosis). Hip fractures become more prevalent as people grow older because bones become less dense. People with osteoporosis could get a fracture even from simple, everyday activities. Aseptic necrosis can happen if you have been on steroids for a long time, if you have sickle cell anemia, if you have been a regular user of alcohol, or if you have had injuries near the hip recently. Degenerative disk disease (DDD)***** (see Degenerative Disk Disease @ BillDoll) The five stars denote that this (DDD) is an important category for those suffering from chronic, severe leg pain, usually thigh and above, and lower back. Type of doctor suggested: Orthopaedic doctor/Bone & Joints specialist. You may also try a chiropractor, but the first priority should be orthopedic. Symptoms - The most common early symptom of degenerative disc disease is usually pain in the back that spreads to the buttocks and upper thighs. See a nice article on DDD here @ All about Back Pain Spinal stenosis (see Spinal Stenosis @ BillDoll) The spinal canal runs through the vertebrae from top (base of the skull) to bottom (the tailbone) and provides a passageway for the nerves running to the lower extremities. A narrowing of the spinal canal is called spinal stenosis, which can cause neck or leg pain, weakness of the arm or leg muscles and/or numbness in the arms or legs. Type of doctor suggested: Spine specialist / Chiropractor Symptoms - The main symptoms of Spinal Stenosis are felt in the legs - heaviness, weakness, and pain in the legs with walking or prolonged standing. These symptoms are usually caused by the nerve roots getting squeezed, which upsets the normal signals traveling from the brain to the body. Symptoms often disappear with rest. Sitting down seems to take pressure off the nerve roots. See a useful article on Lumbar Spinal Stenosis from All about Back Pain Neoplastic Type of doctor suggested for all the illnesses in this section: Oncologist – Cancer specialist Osteosarcoma – Osteosarcoma @ BillDoll, Osteosarcoma FAQ from Cancer Index Ewing’s sarcoma – Ewing's sarcoma is a malignant (cancerous) bone tumor that affects children. Ewing 's sarcoma can occur any time during childhood, but usually develops during puberty, when bones are growing rapidly. It is uncommon in African-American, African, and Chinese children. The tumor may arise anywhere in the body, usually in the long bones of the arms and legs, the pelvis, or the chest. It may also develop in the skull or the flat bones of the trunk - Ewing’s Sarcoma FAQ – Cancer Index, Ewing’s Sarcoma – from Medline Plus Medical Encyclopedia Osteoid osteoma – Osteoid Osteoma – from eMedicine Metastatic bone disease (bronchogenic) Infectious Acute Infectious Arthritis – Infectious Arthritis Info from Health A-Z Osteomyelitis – Osteomyelitis – from MedLine Plus Cellulitis – Cellulitis – from Mayo Clinic Traumatic Symptoms: Severe pain in the affected area, usually after an injury or an accident. This pain will not have occurred before the injury or accident and hence is not chronic. Type of doctor suggested: See your primary care physician / family doctor, and she/he will be able direct you to a suitable specialist. Soft tissue injury Fracture As mentioned above, this type of pain is usually not chronic Mechanical Leg Pain Type of Doctor Suggested: GP (General Practitioners), Orthopaedic Surgeons, Podiatrists? – Still checking this Chronic Lower Leg Pain in Active People Exercise induced leg pain is an example of mechanical leg pain. This type of leg pain is common in athletes and sportspeople. This pain could be severe, but is usually not chronic. This category of pain is usually not chronic Summary: The most important categories for chronic leg pain are (type of doctor in brackets): Vascular (Vascular specialist/surgeon) Neuropathic (Neurologist) Musculoskeletal (Primary care physician as a starting point) Metabolic (Endocrinologist for Diabetes) Referred (Neurologist – Sciatica; Orthopedic doctor – degenerative disk disease) Chronic leg pain is more likely to be because of one (or in some cases more) of these diseases: Varicose veins Peripheral vascular disease Vein thrombosis Neuropathic diseases Restless leg syndrome Arthritis Diabetes induced leg pain Sciatica Degenerative disk disease Section 3 – Choosing the Right Doctor/s to Visit Once you have a short-list of the probable category/categories to which your leg pain belongs, and the corresponding type of doctor to visit, please set up a meeting with your family doctor or a doctor/medical specialist whose opinions you respect. Show him the research you have done and ask for his opinion. At this stage, there is a possibility that he might find your conclusions/short-list to be incorrect (it happened in my case). If he feels so, show him the complete list of leg pain categories provided above and get his help in arriving at a more appropriate short-list of leg pain categories. With this done, request him to suggest suitable specialists. He might suggest more than one specialist for each type/category, in which case you try to arrive at a prioritized list with his help (“Doctor, you have mentioned the names of two vascular surgeons. Which of the two do you feel I should visit first?”). Once you have arrived at a list of doctors to visit, using this method, visit all the doctors, perhaps in a prioritized manner. The total number of doctors you might need to visit could be anywhere between 4-8, and it does appear to be a cumbersome task to meet all of them, but it is usually worth the effort, unless of course one of the first doctors you visit is 100% certain about his diagnosis and you wish to start the treatment with him right away (I would still suggest you visit the rest!) To do before visiting the doctor: Kindly try to put down your thoughts on each of the following aspects before visiting your doctor so that he/she is able to diagnose your problem quickly: Identify the part of leg where pain is: Part of the leg could be: Upper Leg/Thigh, Middle leg/knee, Lower leg/shins/calf, Ankle, Feet, Toes (Digits) Identify the anatomy part involved: Anatomy in the leg portion: Knee caps, Bones & Joints, Nerve, Muscle, Skin, Arteries & Veins Identify the type of pain: Types of Pain: Spasms, Dull aches, Tingling, Burning, Shooting pain, Numbness, Feeling tight, Sprain, Intermittent, Recurrent, Throbbing, Swelling, Heavy, Cramping Section 4 - What if the pain does not go away even after you visited a few doctors? Checklist: Did you visit doctors of at least 2 different specialties, from the initial research you did based on your symptoms? Did you feel that these doctors listened to you carefully Did they come across as knowledgeable in their fields? Did you follow the advice / prescription provided by the doctor/s properly? Did you report to them on a regular basis about your success/failure? Please consider each of the above points and give an answer of Yes or No. If the answer to only question 1 is a No, please visit a doctor of at least one another specialty If the answer is a No to 2 and/or 3, please choose a better doctor in the same specialty and meet her/him immediately If the answer to 4 and/or is a No, please start following the doctors’ advice properly and report to them regularly with the status of your pain. If the answer to none of the five questions is a No, then you can consider the following: Visit one another doctor from the same specialty/specialties – such severe pain is certainly worth a second try If the pain persists even after you have done Step 1 and given the prescriptions some time to deliver, then you will have to consider at least one another specialty doctor to visit, based on your symptoms. It is appreciated that sometimes these iterative processes could take quite a while – if you are unlucky, it could take even longer than six months - but this is probably the most scientific way to proceed rather than hope that someone will come up with a quick fix soon. Hope alone is never a good strategy. Section 5 - Causes for Leg Pain -There are a number of causes that can cause leg pain 1. Thrombophlebitis - an inflammation and clotting of the veins—creates a feeling of heaviness, along with a throbbing or burning sensation below the skin. In its "superficial" form, this disease produces tender skin redness and is not cause for concern. But deep vein thrombophlebitis (DVT) can produce sore, oozing skin ulcers. And a DVT clot that breaks away could be fatal if it lodges in the lungs. 2. In addition, insufficient blood flow from atherosclerosis (hardening of the arteries) can lead to what doctors call intermittent claudication. A person who has this condition experiences a dull cramping sensation that comes on with exercise (when the muscles require more oxygen-rich blood) and goes away with rest. Intermittent claudication, which is fairly common, usually shows up in the calves but sometimes appears in the upper leg as well. In rare cases, blood flow problems can be caused by a limb-threatening aneurysm (ballooning) in an artery behind the knee. 3. It's also possible for leg pains to originate somewhere other than in the leg, particularly in the spine. This is called referred pain. Any abnormality in a disk or the spinal canal - a tumor, an infection - can refer pain to the legs with little or no pain in the back. Sciatica is a common type of referred pain. The sciatic nerve runs from the spine down the leg. Just sitting on a hard stool or wearing a tight work belt can pinch the nerve upstairs and produce a stabbing pain farther down the leg. 4. The leg itself can experience constrictions of nerves that produce burning, tingling, numbness or weakness. This kind of pain often shows up in people who sit, squat, stand or kneel for long periods. 5. Finally, the cause of pain can be in the bone itself. Osteomyelitis, for example, is an infectious bone disorder that can be acutely painful. .. .. Section 6 - Some simple suggestions & notes for various chronic leg pain related problems Be heart smart. The same lifestyle changes that can prevent a heart attack can reduce vascular leg pain. Give up smoking, stop eating fatty, cholesterol-laden foods and shed some pounds. A regular exercise program, especially a walking program, will re-establish quality blood flow throughout the leg. Find exercise alternatives. People who have shin splints should cut back on the activity that brought on the pain (usually running) and find less stressful alternatives, like biking or swimming Work your abs. Sit-ups and other stomach-strengthening exercises can relieve strain in the lower back, thus reducing referred leg pain Empty your pockets. Sitting on your wallet can bring on sciatica. Wearing tight belts and tight pants can also irritate nerves Use padding. Cushioned seats or knee pads can lessen the severity of hard surfaces and prevent sciatica and nerve compression Section 7 Breakthroughs, Inventions & Discoveries for Leg Pain Diagnosis & Treatment Pain Management Technologies – Electrotherapy Devices & More Pain Relieving Adjustable Leg Support – from Free Patents Online New Invention Saves Pain for Patients and Doctors - Making needles easier to give and easier to take – University of British Columbia The NeXt Stop - One small metal invention saves time and money while fixing a common back ailment of the elderly – SF Gate, Feb 2006 Creating new veins to ease pain - Radiologist here replaces blocked blood vessels with synthetic channels -  Spokane radiologist Rod Raabe has begun implanting artificial veins inside blocked blood vessels in patients’ legs to help restore blood flow and eliminate leg pain that can be debilitating. 1998 article – Spokane Journal of Business Section 8 - Some (hopefully useful) notes The pain of sciatica usually occurs in the back of your buttock and travels down the back part of your thigh. Sciatica very rarely travels past your knee and does not cause weakness to your thigh, leg or foot. The soft tissues in the leg and back that are most often injured and affected include: Circulatory vessels & Nerves from the Abdominal area Nerves from the Lumbar Spine Contracting Muscle tissues (spasm & cramping) Contracting Fascial layer restriction Most low back and associated leg pain is caused by mechanical defects in the alignment of one or more segments of the spine. These spinal segments may be displaced by a fall, accidental or back strain. Another frequent cause is chronic posture decay - when a spinal segment is displaced, the supporting muscles and ligaments may be stretched or torn, causing acute and disabling back pain. The spinal nerves, which supply the legs, pass through the openings between adjacent segments of the lower spine. When one of the segments is displaced, the nerves to the leg may be pinched or irritated, which brings about the nerve pain that extends down the leg. The result: excruciating pain. Lumbago and rheumatism are both caused by abnormal conditions of the muscles. The lower back, hips and thighs are particularly susceptible. Neuritis is an abnormality of the nervous system. Nerves become inflamed, accompanied by congestion, swelling, heat and redness in the affected areas. Sciatica is an abnormal condition of the great sciatic nerve. A visitor at a message board says: I take 1mg Requip (ropinirole) 1 hr. before bedtime, also in AM. This has stopped the restless legs & also foot & leg pain (cramping pain)…so far. The following is a question-answer combo: Q: “I suffer from pain in the lower legs and feet along with heavy breathing while walking and running. Please advice”. A: “it is a good idea to continue with your walks at a medium pace. Discontinue the running. After you return from your walk soak your feet in warm water for 10 minutes and do some toe and ankle movements alongside. It is also advisable to wear comfortable walking shoes. In addition do some deep breathing (abdominal breathing) while you sit to soak your feet. Try this program for a week.” Question: “I have had the symptoms of burning feet and lower leg pain for 2 years. The pain is extreme and is present almost daily. I have been to a neurologist and had nerve conduction series done. What type of doctor is best suited to diagnose things such as erythromelalgia?”; Doctor's Response: “There are many causes for burning feet and lower leg pain. Sometimes the diagnosis can be difficult and may only become apparent over time. Neurologists can often provide diagnoses for these symptoms. A reasonable alternative would be a rheumatologist. A rheumatologist is an internal medicine doctor with special training in the evaluation of tissue pain syndromes” Question: “Do you have pain in the back of calf along with swelling of calf & leg?”. Ans: Your pain and swelling may be from a clot in the deep veins, deep venous thrombosis or ruptured baker’s cyst” Question: “Do your calves ache after walking, and is your pain relieved after rest?”. Ans: “Your muscles may not be getting enough blood because of the hardening of the arteries” Blockage of Leg Arteries – Alternative Names: Arterial Insufficiency of the Legs, Calf Pain with Exercise, Intermittent Claudication, Recurrent Leg Cramping, Recurrent Leg Pain, Vaso-Occlusive Disease of the Legs One of the first signs of PVD can be claudication, or pain on walking. The pain, which is caused by constricted blood flow, usually stops after a few minutes' rest. Symptoms of DVT: (a) leg pain in one leg only, (b) leg tenderness in one leg only, (c) swelling (edema) of only one leg, (d) increased warmth of one leg, (e) changes in skin color of one leg, redness Although peripheral neuropathy can occur at any age, incidence is highest in men between ages 30 and 50. Diagnosis of Peripheral Vascular Disease - If your doctor suspects you may have peripheral vascular disease, he or she may use an ankle brachial index (ABI) test, an ultrasound Doppler test, or an angiogram to help diagnose the disease. ( see this page for more details on each of these diagnosis tests) Byetta & Leg Pain? – Though so far there has been no scientific analysis of this, a few users of Byetta ( a drug for diabetes) have complained of severe leg pain after its use. The users are not sure that there is a connection between Byetta use and the leg pain, but there appears to have been a few cases where the two were coincidental – see here from the Diabetic Network. Section 9 - Links & references for chronic leg pain Atherosclerosis Lower Extremity Atherosclerosis Claudication Claudication Versus Other Kinds of Leg Pain Claudication – When Circulation Problems Cause Leg Pain – Mayo Clinic Intermittent Claudication – Cause, Treatment & Symptoms of Leg Pain Claudication – When Circulation Problems Cause Pain - CNN Claudication Information from PennState Could be having vascular insufficiency and claudication. In this instance, the blood supply to the leg is insufficient. After some walking, it can cause severe pain, called claudication. Diabetes & Leg Pain Leg Pain – from Diabetes Self-Management Diabetes, Diabetics & Lower Limb Amputations DVT Tim Hentzel’s Deep Vein Thrombosis Page Deep Vein Thrombosis Explained - CNN Deep Vein Thrombosis – from BUPA Fibromyalgia What is fibromyalgia? And how is it related to leg pain? – About Fibromyalgia; see a discussion forum here on FM Lower Back Pain Exercises for the Lower Back Exercises for a Healthy Back Lower Back Pain – A Logical Question-Answer Based Diagnosis – Family Doctor Low Back-pain Problems – from The Analyst Lower Back & Leg Pain, Patients Fact Sheet – from LowBackPain.tv Anatomy of Low-Back Pain – Back Pain Forum Back & Leg Pain Symptoms and Treatments Available - Medtronic Exercising with Chronic Back Pain – CNN Health Lower Leg Pain Causes of Lower Leg Pain – from Park Nicholas Health Advisor Lower Leg Tingling @ Night Ankle Pain & Tendinitis – From MedicineNet Ankle Pain – Causes, Symptoms, Conditions & Treatments – from About.com Find Relief from Ankle Pain & Sprains - FootSmart What I Discovered about Heel & Foot Pain Ankle Pain – from MedicinePlus Medical Encyclopedia Foot Pain – Causes, Diagnoses, Treatment & Prevention of Foot Pain, from About.com Musculoskeletal Lower Extremity Musculoskeletal Disorders – A Guide to Diagnosis & Treatment Testing for Musculoskeletal Abnormalities – Tests described are: Adson's Test, Anterior Drawer, Apley's Tests, Finkelstein Test, Gaenslen's Test, Godfrey's Test, Hawkins Sign, Ischemic Forearm Testing, Joint Aspirations, Lachman Test, 31P Magnetic Res. Spectroscopy, McMurray Test, Neer Sign, Patrick's Test, Spurling Sign, Steinberg Test, Walker-Murdoch Sign, Wright's Test, Yergason Test Neurological Extreme Leg Pain – Neurology & Neurosurgery Forum & MedHelp Neurologic, Musculoskeletal & Vascular Causes of Leg Pain Diabetic Peripheral Neuropathy as a Cause of Leg Pain – Patient Care Online Night Leg Pain & Cramps Night Leg Cramps – What Causes Them? – Mayo Clinic Nocturnal Leg Cramps – Info & Treatments Nocturnal Leg Cramps – from Stanford University Nocturnal Leg Cramp – from Healthcare South PVD Peripheral Vascular Disease & Treatments – BBC Health Peripheral Arterial Disease, Diabetes & Reduced Lower Extremity Functioning Blockage of Leg Arteries – Dr. Koop Peripheral Arterial Disease FAQs – from the Vascular Disease Foundation Restless Leg Syndrome – The exact classification for this is uncertain; it appears to be a neurological disease but even medical research does not exactly what causes it. Restless Leg Syndrome – from eMedicine Health – a comprehensive and very useful resource, must-read for those who suspect they have this disease Severe Throbbing Pain – to a question on this topic, a doctor suggests Restless Leg Syndrome Restless Leg Syndrome – RLS Info Page from National Institute of Neurological Disorders Restless Leg Syndrome Causes, Diagnoses, Symptoms & Treatment @ Medicine Net Requip manufactured by GlaxoSmithKline is the most frequently prescribed antidote. The precise mechanism of action of Requip as a treatment for Restless Legs Syndrome (also known as Ekbom Syndrome) is unknown. Although the pathophysiology of RLS is largely unknown, neuropharmacological evidence suggests primary dopaminergic system involvement. Positron emission tomographic (PET) studies suggest that a mild striatal presynaptic dopaminergic dysfunction may be involved in the pathogenesis of RLS. (Dopaminergic means "related to the neurotransmitter dopamine". A synapse is dopaminergic if it uses dopamine as its neurotransmitter. A substance is dopaminergic if it is capable of producing, altering, or releasing dopamine. A dopaminergic, or dopaminergic agent, is any chemical which functions to enhance the effects mediated by dopamine in the central nervous system. These include dopamine precursors and cofactors, dopaminergic enzymes, as well as dopamine reuptake inhibitors. The Natural Medicine Approach to Restless Leg Syndrome - A better approach is to determine and treat the underlying cause of the condition. Almost all individuals with restless leg syndrome are low in the minerals potassium and magnesium. Tests would be done to establish the levels of these two, and if they are low, supplements are prescribed. Tight leg muscles also appear to be common among restless leg syndrome patients. If this is determined to be the case, a stretching program is recommended. In case improper circulation plays a role, a platelet aggregation test is done to determine the thickness of the blood. Thick blood contributes to poor circulation. If the platelet aggregation test is positive for thick blood, a supplement like VSCLR is ordered. And finally, patients are urged to wear toe stretchers at night to stretch the toes, foot and calf. Requip Restless Leg Syndrome Treatment Sciatica Sciatica & Legpain from Chirocare India – also has Chiropractic educational resources Sciatica Information – from Sciatica Clinic Sciatica – Pain from the Sciatic Nerve (Sciatica – from Back.com) Case Studies, Treatments & “Equipments” Chronic Leg Back Pain Help from Aircast Using Medtronic Pain Therapy Intrathecal Drug Delivery to Treat Chronic Back and Leg Pain Chronic Leg Pain Treatment Using Thermaphore Back & Bilateral Leg Pain Responds to Intrathecal Drug Delivery Leg Circulation Enhancing Products @ FootSmart Carnitine Treats Blocked Leg Arteries – 1997 Article A Man Presenting with Leg Pain & Weakness – from MedScape. Case of a patient with Patient with vasculitic peripheral neuropathy Cyclosporin Treatment in Psoriatic Arthritis – A Cause of Severe Leg Pain – a case study Back & Bilateral Leg Pain Responds to Intrathecal Drug Delivery – Medtronic case study A Successful Conservative Approach to Managing Lower Leg Pain in a University Sports Injury Clinic – BJSM Online (PDF) Using MedTronic Pain Therapy Drug to Treat Chronic Leg & Back Pain ( see also: Chronic Back & Leg Pain Page) New Procedures & Treatments (How new??) New Procedure to Treat Severe Leg Pain ( see also: New Hope for Patients with Severe Leg Pain - PDF) Low-technology Rehabilitation Technique for Chronic Leg Pain New Treatment Relieves Diabetics’ Leg Pain – Topix.net Article New Treatment Stops Some Leg Pain - WebMD - Freezing Treatment Offers New Hope for Easing Leg Pain Caused by Hardening of Arteries Move Your Arms to Beat Leg Pain, Study Says – Medical New Today – Scientists at Sheffield Hallam University have discovered that simple arm exercises could help beat a crippling leg condition that affects one in twenty people over 55 in the UK.  The team, along with staff at the University of Sheffield, has found that upper body aerobic exercise can help the battle against peripheral vascular disease (PVD), a blood circulation problem, which causes severe leg pain and leaves patients struggling to walk even short distances…. The Rest Low Technology Rehabilitation Technique for Chronic Leg Pain - Some quotes: Sitting, a necessary evil complicated by incorrect posture, produces eleven times more pressure on the third lumbar disc than a supine position Undiagnosable Leg Pain – from Drugs & Medications Forums @ Drugs.com Back & Leg Pains Symptoms & Pain Treatments Available - Medtronic How to Find Lasting Relief from Leg Pain From Google Answers: Help for Foot Cramps, Spreading Toes, Calf Pain The Care of Patients with Chronic Leg Ulcer (PDF) Blood Clots Information – from University of Florida Shands Cancer Information Center (PDF) Podiatry & Sports Podiatry Information How to Find Lasting Relief from Leg Pain Leg Pain – A Hidden Risk for Stroke or Heart Attack Info on Leg Pain Due to Poor Circulation - FootSmart Chronic Leg Pain – Putting the Diagnostic Pieces Together – from The Physician & Sports Medicine Clot-busting Drugs Prevent Leg Pain, Swelling - WebMD Pain the Leg Warrants Attention - WebMD Lumbar Spine Stenosis – A Common Cause of Back & Leg Pain Calf Strain Information – from Sports Injury Clinic