Muscle spasms, cramps, and nerve pain

[KimT]

Hi Everyone,

I'm not even sure how to compose this e-mail because I'm in pain and I'm not even sure if all of it, some of it, or none of it is ALS-related.

About a month ago, what I thought was severe cramping in my periformis muscle (because the nerve irritation went all the way down my left leg into my foot and I could make it more irritated by touching any of the area it affected) I went to a massage therapist. The MT had been a nurse and was very aware that my hamstrings and parts of my back were tight. I've always had trouble getting massages lying on my face because of neck soreness and a dislocated TMJ from a MVA. I managed to let him work on me for about 20 minutes that way, then he got a body pillow and worked on my left hip, glutes, etc. I went back once a week for two more weeks. After the first week I noticed pain in my front intercostal muscles. I figured he put too much pressure on my back (I'm very small boned) and my front ribs pushed too far into the table. This pain was not bad and it didn't restrict my activity. The second week he did more work on my lower back because he thought he could release the spasms he felt. Now my lower back joined in with pain but I dismissed it because the glutes felt better and the actual massage didn't hurt. The last week he stretched my back muscles and I thought all was well until the next day.

Fast forward a week and a half....now I'm getting muscle pain all day long in front and in my mid and lower back. When I take a deep breath, my lower back hurts worse. The only relief is flat on my back alternating the heating bad up and down my torso in the back and on the sides. I've tried to gently stretch it out but nothing helps. I've started taking Advil, Aspirin, and Tylenol. I have lidocaine patches but they don't seem to help. Extra Valium takes the edge off but I'm not sure if it's due to the muscle relaxation or just making me sleepy and better able to sleep.

I'm still having ongoing cramps in my legs and glutes.

I can still walk on my toes and heels but this trunk involvement scares me and I cannot get comfortable sitting up.

I'm in a State where I can't get MM.

I do use cushions and a very good ergonomic chair for my computer. It has excellent postural and lumbar support.

I can take a deep breath but, when I do, it hurts.

 

[lgelb]

Hi Kim,
Do you think it's new nerve, or muscle pain? What does ice do?

 

[KimT]

Laurie, I really don't know. It feels like pulled muscles. It seems like stretching them out made them worse. Back a year ago I woke up one day with intense pain in my right front intercostals. The pain lasted for a month, then slowly went away. I have no idea why. It was when I was doing through the diagnostic process at Mayo. They blamed my poor PFT on it but the PFT didn't improve even though the pain resolved. Back then ice did nothing.

I didn't try ice this time because the heat felt so good. I know if it was an acute strain, I should have used ice.

 

[ShiftKicker]

Kim-
Do you think that the massage may have put something out of place and you have a pinched nerve somewhere? With a combination of weakened muscles and spasticity pulling things all over the place, your back and/or ribs may just be in wrong place and placing more strain on already burdened muscles.
I hope it resolves itself soon, and you get some relief from pain.

Fiona

 

[KimT]

I guess time will tell.

 

[lgelb]

Kim,
As I'm sure you know, Tylenol (acetaminophen) and Advil (ibuprofen) shouldn't be taken together as they are NSAID cousins. For the "pulled muscle" possibility that seems most likely, ibuprofen or naproxen (the latter often more easy on uneasy GI tracts) would be more likely than acetaminophen to reduce inflammation.

It may seem counterintuitive but you might consider getting a PT eval with an eye toward therapy that would address both the original problem and the new one. Some PTs are also MTs.

 

[KimT]

Laurie, I know that Ibuprofen and Aspirin are NSAID, but I thought acetaminophen was a general pain reliever and not a NSAID. For that reason, I've been resisting taking Bayer and Advil together but supplementing with Tylenol strictly for the pain and because Tylenol doesn't bother my stomach. I have to watch out with both ibuprofen and aspirin because they bother my stomach. Maybe I should try naproxen and see if it is easier on my stomach. I do use coated Advil and take it immediately after eating. The last thing I want is a stomach bleed. My stomach is already loaded with polyps from 15 years using a proton pump inhibitor for severe GERD (had no idea this was a side effect until my gastro told me five years ago.)

I do have a PT friend who is very "hands on." She got her doctorate in PT later in life (40s) and has been practicing for a little over 10 years. She knows nothing about ALS but has worked with stroke victims and maybe even MS. I have an Rx from my neurologist for PT twice a week but have not used it yet. Maybe it's worth a try.

Honestly, I'm physically and mentally exhausted. I have a bathtub with jets and I thought about filling it up, adding some epsom salts and seeing if that would help. A friend brought me lunch yesterday. I had taken 1 advil, 1 tylenol and 1 five mg Valium right after breakfast so I would be able to sit and eat with her. I took another round six hours later so I could sit with my brother when he came over that evening to play cards.

It just feels like I'm juggling too many balls. I wish my BiPAP and Golden chair were here.

Thanks for the PT suggestion. I think it's a good one.

 

[KimT]

I also have some Neurontin from when my shoulder was frozen a couple of years ago. It's low dose (100 mg.) and I thought I might take one to see if it helps.

I have an appointment in Jacksonville Thursday and an appointment with my local neuro in three weeks. The local neuro is more of a specialist in pain management. He owns a pain management clinic.

 

[lgelb]

Well, I put it clumsily and misleadingly. While acetaminophen is technically not an NSAID itself, it increases the risk of gastric bleeding in combination with NSAIDs and I remember you had stomach issues.

Neurontin will do nothing for muscle pain and I wouldn't add it to the regimen you have going since the risk of side effects increases with each med that acts on the brain (Neurontin is at root an epilepsy drug.)

 

[KimT]

Thanks, Laurie. I was a little afraid of the Neurontin, anyway.

My brother's doctor told him not to take Ibuprofen. I honestly think he is confused. He said his liver wasn't "perfect" per blood work. I told him it was Tylenol and drinking one drink every afternoon that should concern him about his liver. He insisted his doctor said it was the Ibuprofen. He now takes 2 Tylenol (regular strength) in the morning and two regular strength aspirin at bedtime. I wish I had his stomach. He can eat anything. He'll be 80 this year, is a colon cancer survivor, and Lupus in remission for over 30 years. He has RA and was doing extremely well with two Advil per day. His blood pressure was normal. I still think he is confused but he is very stubborn.