Leg Pain

There are a number of conditions which can cause chronic leg pain. Of course in each case a physician would want to find a correctable cause by which the pain would be permanently resolved but sometimes this not possible. Joint replacement of knees and hips have come a long way with relief of chronic pain but sometimes even these don’t resolve joint pain entirely. A combined effort by several collaborative medical disciplines such as orthopedics, internal medicine, rheumatology, and physical therapy can sometimes achieve relief of chronic leg pain. In other cases, pain management becomes the objective and medicines are skillfully prescribed to accomplish this goal.

 A common cause of chronic pain is at the aftermath of a significant injury. Bony fractures may heal in a shortened or otherwise deformed fashion. There can be permanent muscle injury or damage to nerves which is irreversible. Burns can leave contractures and damage to muscles and nerves. Orthopedic surgery can often maximize function in these types of injuries, but there can be residual pain from the surgery itself. Medical treatment has several approaches. There are five classes of NSAIDS (medicines like Motrin) which can be effective in relief of pain. Sometimes antidepressants like Cymbalta can lessen pain by altering neurotransmitters in the brain .There are non-narcotic medicines like Ultram which can significantly reduce pain. Psychological techniques like meditation can be effective, and in some cases techniques like acupuncture can offer relief. If all of these interventions have been tried and there is still an unacceptable level of pain, the physician may legitimately enter into a contract with the patient to prescribe narcotic medication. Several safeguards are required. Usually a drug screen for non-prescribed drugs is done once a month. The physician has to carefully monitor the amount of drug being used to ensure that the patient is not increasing his own dose without the physician’s permission. The biggest “no-no” in this physician contract would be if the patient was obtaining controlled medication from more than one physician. This would cause for immediate cancellation of the contract and the physician’s refusal to prescribe anymore narcotic medications.

Another type of leg pain is vascular. If the arteries become blocked by atherosclerosis, or “hardening of the arteries,” then the muscles and nerves can receive too little blood supply. These tend to hurt when the patient walks a certain distance or otherwise exercises his legs. Ideally some sort of surgery to open the artery or bypass the obstruction would be desirable.  In many cases this is possible; however, if there are too many obstructions, medical therapy may be solely necessary. Drugs are available which can cause arteries to relax and allow better blood flow. Sometimes the statin drugs can reverse some of the atherosclerosis. Given cases where these therapies do not work satisfactorily, the various regimens of specific pain therapy outlined above would be followed. The other type of vascular pain in the legs is venous or involving the veins. This pain tends to be more aching in nature and usually involves visible varicose veins. Support hose can be helpful. Elevating one’s feet three times a day can likewise be beneficial. There are specific procedures now by which the veins causing the problems can be closed by inserting a laser in them. It is virtually painless and quite effective.

Another specific cause of pain in the legs is diabetes mellitus. This disease injures both the nerves and the arteries in the legs. Furthermore it frequently causes ulcerations of the legs and which if serious, enough can lead to amputation. The foundation for treating these types of problems in diabetics is tight blood glucose control.  Since atherosclerosis is more common in diabetics, the surgical procedures to improve blood flow may help. Sometimes if all the complications of diabetes have been addressed, it is necessary to give controlled pain medicines to cope with the pain. This would follow the same regimen previously described.

A final type of leg pain that bears mentioning is restless legs syndrome. This primarily occurs during periods of inactivity, particularly when trying to fall asleep. It can give aching, tingling, or several other forms of pain which are relieved by moving the legs. Treatment begins with good sleep hygiene, i.e., going to bed the same time every night, etc. If symptoms persist there are several types of drugs which can help. Sometimes anti-Parkinsonian drugs like Requip are prescribed. Sometimes muscle relaxants like the benzodiazepine Clonazepam are given. Finally some of the anti-seizure medicines like Neurontin may be very effective.

This is not an exhaustive discussion of leg pain, but it does tell some of the diagnostic clues for determining cause, and hence, treatment. If you are having recurrent pains in your legs, consult your physician for a diagnosis and treatment.