Q: I am suffering from pain in the upper/lower limb since last 10 years. I had joint pain in knee, elbow, neck etc. Then I had unwanted child abortion which caused weakness. I have also been admitted due to severe low back pain. Further diagnosed with Polyarthralgia/Tissue disorder. Tested for RA (negative), ANA (negative). I have been trying homoeopathic medicine as allopathic could not help me. But again since last 15 days my condition is very bad. I am very uncomfortable due to severe pain in buttocks, below the right rib, lower part of the back and legs. The pain radiates between these parts. Specially sudden spasm (stroking) agonise me a lot which results in screaming all the night. I am totally confused and helpless because my pain is unbearable. That is why I am writing to you. Please study my case in detail and help me?

A:Possibly the most important point in your history is that despite 10 years of aches and pains and different doctors, different systems of medicines and different diagnoses, you remain the same, as you were 10 years ago. The disease has not progressed in 10 years. This is rather typical of hyper vigilance syndrome (old name fibromyalgia) where the normal sensory impulses that every one keeps having all through the waking time, get converted into electrical impulses at the brain level. (Normally these impulses never reach the brain level, in some individuals like yourself, there is decreased threshold for sensory impulses, hence the name ‘hyper vigilance’). These electrical impulses cause muscle spasms in different regions of the musculoskeletal system - mainly the neck-nape region, upper arms and legs, low-back. Such patients do not show any abnormality in their blood tests and do not respond to the usual treatments that are given for pains (namely painkillers - that are totally ineffective in this condition). What you need is to be under the care and guidance of a rheumatologist who has facilities to give you appropriate occupational therapy, physiotherapy and teach you proper aerobic fitness exercises. Many patients also benefit with amitriptyline 10 mg daily taken 2 hours before going to bed. This medicine MUST only be prescribed by your rheumatologist after he/she has evaluated your case in detail. The effect of this medicine starts in ~ 3 weeks. If the response is not complete in 6 weeks the dose may be increased to 25 mg daily 2 hours before going to bed. This medicine has to be taken for months or years. Hope you feel better.