In need of your collective wisdom

  1. Let me start by saying that I'm posting this with permission on behalf of my friend. She's been going to doctors for this problem and can't seem to find an answer. I'm not sure what to say to her so I thought I would post this here and maybe (hopefully) someone here would at least have an idea where to go next.

    My friend is a 41 year old woman with two kids aged 15 and soon to be 12. When she was pregnant with her first child she developed a nasty pain in her lower back. Doctor said she had facet syndrome and left it at that. Back-strengthening exercises got her through her pregnancy without much trouble. After the baby was born she discovered that when she pressed on her lumbar spine she experienced what she discribes as an "exquisite" pain. Her husband once pressed on her lower back and she said the pain reduced her to tears. It doesn't hurt when she moves but the pain on palpation does get worse when she's tired.

    She went to a rheumatologist about 10 years ago and even though this doc tossed around a few diagnosis' (fibromyalgia and ankylosing spondilitis) none were ever confirmed and followe-up. She did discover around that time that she had developed Hashimoto's Thyroiditis over the previous few years and is now on synthroid.

    A few years ago the pain on palpation started to spread down to her hips and legs. She tried to exercise but found that doing floor work was next to impossible since her back and her hips hurt too much when she was lying on them. Now she has pain in her back, hips and the outside of her thighs right down to just above her knees.

    The really odd thing is that she has no pain moving and that the muscles don't actually ache. I poked her hip with my finger and she jumped..I didn't even push hard, about as hard as you would say push a doorbell. She can lie on a soft surface but not a hard. She can also pinch the outside of her thigh without pain. It only seems to hurt when she presses against the bone.

    She's been to a few docs and they all seem to end up treating her the same, like it's all in her head.

    She says she's been tested for RA and lupus. She says she has some of the fibromyalgia tender pressure points but no other pain. Thyroid is okay. All other blood work is fine according to doc. She even had a total body bone scan once which came back normal. She's overweight, with a BMI of 30

    Could all this be fibro?

    It doesn't stop her. She's a healthy, active woman (although not as fit as she could be). But she would love to know what on earth is wrong with her.

    I have no idea and was kind of hoping that your collective wisdom would help unravel this.

    Thanks on behalf of my friend.
  2. Visit laurasc profile page

    About laurasc

    Joined: Oct '00; Posts: 310; Likes: 107
    Nursing Supervisor
    Specialty: 26 year(s) of experience in Gen Surg, Peds, family med, geriatrics


  3. by   IMustBeCrazy
    "Vitamin D Deficiency May Cause Undetermined Muscle & Bone Pain

    A report in the December issue of Mayo Clinic Proceedings indicates that individuals who experience muscle and bone pain of undetermined origin-the most common complaint of patients who visit primary care physicians-may be deficient in vitamin D.

    Vitamin D deficiency is linked to significant risk for many diseases, including osteoporosis, hypertension, diabetes, cancer, and autoimmune diseases such as multiple sclerosis. Deficiency of this vital nutrient also is harmful for developing fetuses and causes rickets in children. But the link between low Vitamin D levels and muscle and bone pain has remained uninvestigated until the current study.

    Researchers at the University of Minnesota studied 150 children and adults. They found that 93 percent of all subjects with non-specific musculoskeletal pain were vitamin D deficient. In fact, 100 percent of African-American, East African, Hispanic, and Native American subjects were vitamin D deficient. Shockingly, all study patients under age 30 were vitamin D deficient. Of these, 55 percent were severely deficient. The worst deficiency was found in young people, especially women of childbearing age. Five subjects-who had been told their pain 'was all in their head' and 4 of whom were aged 35 years or younger-had no vitamin D at all.

    The authors concluded that people with persistent, non-specific musculoskeletal pain should be screened regularly for vitamin D deficiency. They called for a trial to determine how vitamin D supplementation affects the management of persistent, non-specific pain.


    Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463-70."
  4. by   IMustBeCrazy
    [color=#009999]laboratory findings

    25(oh)d3 and other vitamin d metabolites may be measured in plasma. in healthy persons, levels are 25 to 40 ng/ml (62.4 to 99.8 nmol/l) for 25(oh)d3 and 20 to 45 pg/ml (48 to 108 pmol/l) for 1,25(oh)2d3. in nutritional rickets and osteomalacia, 25(oh)d3 levels are very low, and 1,25(oh)2d3 is undetectable. a low serum phosphorus (normal: 3.0 to 4.5 mg/dl [0.97 to 1.45 mmol/l]) and a high serum alkaline phosphatase are characteristic. serum calcium is low or normal, depending on the effectiveness of secondary hyperparathyroidism in restoring serum calcium to normal. serum pth is elevated, and urinary calcium is low in all forms of the disease except those associated with acidosis. in hereditary vitamin d-dependent rickets, laboratory findings vary.

  5. by   Agnus
    This may seem a bit out there, but has she gone to a Chiropractor? Yes, I know it hurts to touch and that is what Chiaropractors do. But sometimes they have answers and relieve pain that no one else seems to be able to. It might be worth her discussing it with one, and letting him/her do an exam.
  6. by   NeuroICURN
    Quote from Agnus
    This may seem a bit out there, but has she gone to a Chiropractor? Yes, I know it hurts to touch and that is what Chiaropractors do. But sometimes they have answers and relieve pain that no one else seems to be able to. It might be worth her discussing it with one, and letting him/her do an exam.
    Chiropractor....ack, wouldn't let one touch me if THEY paid me!!! Granted, you said her problem is in the lumbar spine, but I've seen too many people that have come in, after a chiropractor adjusted them and dissected their carotid artery! Thanks, but no thanks.
  7. by   melpn
    Tell her to try magnesium supplements (many people are deficient and it seems to help with chronic pain) and send her to a neurologist and an ortho.
    Last edit by melpn on Jun 22, '04 : Reason: added explanation