Hip, Hip, Hoo-arrrgggghhh
November 1, 2012 5:04 PM   Subscribe

I've suddenly developed a weird hip pain issue that it's hard for me to even articulate well enough in order to explain to my doctor without sounding like a weirdo. Have you ever had anything like this?

First of all, I have rheumatoid arthritis which is in an active stage right now and take a boatload of medications for it, including long-term prednisone therapy. I've never had any pain in my hips that I would identify as arthritis pain.

I've had two episodes of a sudden and excruciating pain, one last week which began at night while I was sleeping and once this morning when I was half-awake but still lying in bed. I'm not sure how the first episode began since I was asleep but I awoke because of a sharp pain in my right hip. I kept trying to find a position that would ease the pain with no success and then I suddenly had an excruciating (and I don't use that word lightly) burning pain along my entire shin. I couldn't remain in bed it hurt so bad and kept sitting, standing, walking, constantly changing position trying to find something that would help it. I took some of the strong pain medication I have for emergencies and after maybe a half-hour to an hour was able to finally go back to sleep with the pain easing off. When I awoke a couple of hours later, the pain was gone and there was just sort of a minor residual soreness in my hip. I almost felt as if I had dreamed it all and wondered if I just imagined how bad it was because of my sleeping state.

This morning I had a second episode while lying in bed, on my back, while I was half awake (but certainly not dreaming or imagining it). The same right hip felt as if it had a catch in it or needed to pop. I didn't even think about the previous pain I had in that hip until I shifted position to ease the "catch" and I once again had the sudden excruciating burning pain, this time on the outside of my calf and across the top of my foot into my big toe and in the arch on the bottom side of my foot. It was so painful I was practically hyperventilating and was grunting like I was in labor. Once again I dipped into my emergency supply of pain med, but this time it eased off much quicker, like in 15 minutes maybe. Again, now I just have a faint residual soreness in that hip.

A few other details --
I'm able to walk it on during the episodes without making the pain worse.
I have known degenerative disc disease in my neck, but I don't have any pain in my low back that would lead me to believe it's coming from my spine.
I have a pretty high tolerance to pain and because of my RA am pretty much in constant pain, but the intensity of this pain and my reaction to it (hyperventilating, moaning, not really able to talk) is scary. I was thinking this morning mid episode that there was no way I could drive myself to the doctor or the ER during an episode.

I definitely plan on bringing this to my doctor's attention and I know you are not my doctor and you can't give me medical advice. It just seems like such a weird sequence of events, I'm afraid the doctor will think I'm crazy. I'm really worried about the episodes happening more frequently or even becoming constant (!!!).

Sorry this got so long and thanks for any ideas or light you may be able to shed.
posted by SweetTeaAndABiscuit to Health & Fitness (7 answers total) 1 user marked this as a favorite
Your doctor is definitely the person to talk to about this, but if you're in the middle of a flare I wouldn't be surprised if the inflammation is putting pressure on a nerve bundle somewhere that it doesn't usually. That totally sounds like a pinched-nerve thing to me. It might be related to your neck/back issues, too - that's a question for the doctor for sure - but this does not sound particularly crazy or inexplicable to me.
posted by restless_nomad at 5:10 PM on November 1, 2012 [1 favorite]

I do have some hip issues, nothing extreme like yours, and I do sometimes get shin/lower leg pain which I feel clear is related to the hip joint issues. This does sometimes involve nighttime/sleep discomfort but usually not severe pain. It seems clear to me it has to do with my knees angling differently when my hips are doing weird things. I sometimes wind up with sore muscles in my lower legs when my hips are doing odd things. Again, in my case, it seems pretty clear that the hip joint working differently puts different stressors than usual on the lower leg. When I get this discomfort in my sleep, I am always laying on my side and have been in the same position too long. Changing positions helps, though it doesn't go completely away.
posted by Michele in California at 5:19 PM on November 1, 2012

there was no way I could drive myself to the doctor or the ER during an episode

If you need to go to the hospital and can't drive, it's appropriate to call 911 and go in an ambulance.
posted by insectosaurus at 5:20 PM on November 1, 2012

You have RA.

You are on a number of strong immunosuppressants and immunomodulators.

Your doctor will not think you're crazy complaining about joint pain.
posted by gramcracker at 5:38 PM on November 1, 2012 [2 favorites]

I have hip pain that goes into my groin and shows up in my lower leg. My Doc sent me for a hip and low back x-ray, Hip was normal, low back had spinal stenosis. She felt the pain was caused by the spinal stenosis. I am not in as much pain as your are and control it with advil and a hot shower. If I was in as much pain as you are I would be at the Doc's yesterday.

I have MS and take daily meds for chronic muscle spasms but I knew my hip/leg pain was something other than my MS.

I think you describe your symptoms really well.
posted by cairnoflore at 6:23 PM on November 1, 2012

Sweetteaandabiscuit, what you are describing is neuropathy, i.e. nerve pain - a very different animal from the RA pain you are used to. Neuropathy arises from nerve irritation/damage and does not really respond to conventional analgesics. Besides attempts to improve symptoms by releasing any possible physical strain on nerves (by shifting position, by soothing secondary muscle spasm with heat) and - if persisting - getting an urgent expert opinion, the only (moderately) effective pharmacotherapy is with drugs that specifically act on nerve tissue (see below). It would help if you listed the pain medications (and also any other regular meds) you already take, both regularly and for exacerbations.

RA, as you will know, is a chronic inflammatory condition affecting the soft tissues of many joints - it typically causes more stiffness than pain (worst in the mornings) and is usually bilaterally symmetrical. RA often has a genetic element (runs in families) and characteristically starts either in childhood (juvenile form) or in mid-adulthood. Osteoarthritis, by contrast, is a purely degenerative condition with a later onset and often affects particular joints that have experienced excessive wear and tear. It causes more pain than stiffness.

Neurologically, the shin is innervated by the L4/5 nerve root via the saphenous/common fibular nerve while the outside of the calf and top of the foot incl. big toe is innervated by the same nerve root(s) via the superficial and deep peroneal nerves as well as the median plantar nerve. The hip joint is innervated by the same nerve roots (as well as many others). As these are different peripheral nerves it is unlikely that they are affected peripherally - far more likely that their common origin is the source of the problem. A detailed review of hip pain, albeit with an emphasis on Trochanteric pain, can be found here.

You also mention that you have experienced degenerative disk disease in your neck (presumably cervical disk prolapse). I presume this presented symptomatically with neck/shoulder pain or soreness - how does that compare to your leg pain? That would also have been causing neuropathic pain. How was it treated? Did it resolve? Were you prescribed Gabapentin, Pregabalin or Amitriptyline?

I should explain that I am a UK-based anaesthetist (anaesthesiologist) and pain management clinician, so I'm not sure what the North American trade names for these are.

In summary, if the pain has not curtailed your ability to walk then I think it is most likely that you are experiencing nerve entrapment affecting some parts of the L4/5 nerve root or its major branches, and that is most likely caused by a vertebral problem such as a (minor) disk prolapse.

Bed rest is likely to help the symptoms but obviously doesn't help the diagnostics. If you are lucky it will resolve reasonably soon and in the interim be improved by the neuropathic pain medicnes I mentioned (all of which of course can have adverse side effects on the brain, making you tired, hazy confused and uncoordinated). A local expert opinion would be advised - hope your health plan covers it!

Good luck.
posted by kairab at 5:46 AM on November 2, 2012 [5 favorites]

Yes, I have a herniated disk and arthritis in my lower back and the pressure on the nerve has caused pain in my hip, the front of my calf and top of my foot. Nothing as bad as what you're describing here, though. I would see the doctor soon; this sounds just horrible.
posted by WorkingMyWayHome at 12:21 AM on November 4, 2012

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