Much to the dismay of patients and doctors, pain cannot be seen on a special image like CT or MRI. Focusing on the history and physical examination is key. Here, the burning pain with associated tingling is the key to a diagnosis. Neuropathic pain, possibly complex regional pain syndrome (previously known as RSD), is the most likely candidate causing the bilateral (both-sided) leg pain. Because the symptoms are bilateral, the nerves involved lie in the brain or spinal cord (central nervous system). In a process called central sensitization, the central "alarm system" has become too sensitive to normal, non-threatening situations like walking, sitting, sleeping. These abnormal nerve signals, like a faulty alarm, cause burning pain, numbness, tingling, skin discoloration, itchiness, swelling, or hyper-sensitivity.

Anyone with nerve pain should see a neurologist or pain specialist who understands nerve pain (neuropathic pain) and have a nerve test. Another great source of information is a book called "Explain Pain" by David Butler (a leading expert in nerve pain). This book is available at www.optp.com.

There are many non-opioid (opioids are traditional "pain medications"). A spinal cord stimulator is another option for intractable leg pain. The right specialist will be able to guide anyone with pain towards relief.

Dr. Christina Lasich, MD