Leg pain can arise from a number of sources, based on the anatomy of the leg. Many cases of leg pain originate because of a degenerative process or pathology. Damage to muscles, joints, or ligaments that comprise the leg can also be the main source of both acute and chronic pain. Despite this, there are a number of cases of leg pain where physicians are unable to locate the precise source of the pain. Common causes of leg pain are described below.
Shin splints, also known as medial tibial stress syndrome, are characterized by leg pain, swelling, soreness, and tenderness, particularly along the shinbone or tibia. This pain may temporarily be alleviated with rest; however, the pain and discomfort will likely become more persistent with time. Shin splints are generally the result of injury or irritation of the muscle tissue or tendons located near the shinbone.
Hamstring injuries are caused by the overextension of one or more muscles within the leg, leading to tissue damage and irritation. Individuals with a hamstring injury often experience sudden and intense leg pain, particularly at the back of the thigh and in the lower buttock. Overuse and strain are the most common causes of injury to the hamstring muscles. Not completing a proper warm-up routine before engaging in physical activity or becoming involved in a new activity involving physical exertion after a significant period of time with little to no physical activity can place individuals at risk for damaging the hamstring muscle.
Myalgia is muscle pain that can range from mild to quite severe. Muscle pain associated with myalgia can frequently remediate within a few days; however, in some instances, this pain can persist for several months. Myalgia can occur anywhere on the body, including the legs. Myalgia is linked with high levels of stress, tension, and overuse, as well as minor injury. Generally, myalgia pain is localized and unlike the widespread pain experienced as a result of other underlying conditions.
In some cases, symptoms of leg pain can be an indication of underlying compartment syndrome. Compartment syndrome is a serious condition characterized by the build-up of pressure within various compartments inside the body. These compartments are areas where a number of organs, or other tissue, converge to create a space that is surrounded by strong connective tissue called fascia. Typically the result of an acute injury, compartment syndrome is caused by excessive blood or fluid accumulates within the compartments, causing undue pressure. This pressure not only results in significant leg pain, but also can lead to severe tissue damage. If left untreated, compartment syndrome can lead to more serious conditions, such as loss of body function.
Osteosarcoma is a type of bone cancer that develops during childhood and is typically diagnosed around 15 years of age. The causes of osteosarcoma are currently unknown. Individuals suffering from osteosarcoma typically experience bone pain, limited range of motion, bone fracture, tenderness, swelling, or redness at the site of the tumor. Tumors located in the leg may lead to limping and limited range of motion.
The specific nerves that control sensation in the legs are located in either the lumbar region of the lower back or sacral region of the tailbone. In general, when these nerves become damaged or irritated and inflamed the individual will develop leg pain as a result. Below are several known sources for neuropathic leg pain.
Sciatica is leg pain, particularly along the large sciatic nerve in the back of the leg. Sciatica may also be accompanied by numbness or tingling in the lower back and buttock region. Leg pain associated with sciatica is typically constant, occurs only in one leg, can worsen while sitting, and may make it difficult for the individual to stand from a seated position or walk. The most common causes of sciatic leg pain include lumbar herniated disc, isthmic spondylolisthesis, lumbar spinal stenosis, piriformis syndrome, degenerative disc disease, and sacroiliac joint dysfunction.
Typically occurring as a result of nerve damage, peripheral neuropathy is a condition where pain is experienced within the extremities and may be accompanied by symptoms of numbness or tingling. Over time, individuals suffering from peripheral neuropathy will find it increasingly more difficult to walk and complaints of muscle cramps are common. One cause of peripheral neuropathy is believed to be damage to the motor nerves. This injury, which leads to intense leg pain, may be caused by physical trauma, such as a fall or fracture. Additionally, injury to motor nerves in the leg can be the result of inactivity. Indeed, sedentary lifestyles can lead to increases in the degree of pressure placed on nerve bundles, causing them damage.
Individuals with diabetes are at increased risk for leg pain associated with diabetic peripheral neuropathy. The underlying factors that are believed to account for the pain associated with this condition are metabolic factors (such as high blood glucose), neurovascular factors (such as damaged blood vessels), autoimmune factors (such as inflamed and irritated nerve bundles), mechanical injury to the nerve bundles (such as in carpal tunnel syndrome), genetics (such as family history of nerve conditions), and lifestyle factors (such as smoking or alcohol use). Pain may or may not be evident in this condition; however, should it arise, it is typically experienced in the extremities.
Shingles is a condition associated with a rash, blisters, excessive nerve inflammation, and even nerve damage caused by the herpes varicella-zoster virus (the same virus that causes chickenpox). The pain associated with shingles is characterized as a localized band of pain in the area of the damaged nerve. This pain can occur anywhere on the body, including the legs. In general, symptoms of shingles are expected to improve within several weeks; however, when the neuropathic pain persists, even after the rash, and blisters associated with the original shingles outbreak have cleared, it is termed post-herpetic neuralgia.
Post-laminectomy syndrome refers to a relatively rare pain condition in which pain of unknown cause emerges subsequent to surgery or persists despite attempting surgical intervention. This condition is associated in particular with back surgery, which is also known as a laminectomy. Post-laminectomy syndrome is also frequently referred to as failed back surgery syndrome.
Deep vein thrombosis (DVT) is a condition in which a blood clot, also known as a thrombus, forms within the veins of the leg. Generally, clots are believed to form after an individual has been seated for a long period of time. For instance, individuals are at increased risk for developing blood clots when sitting for extended periods of time while traveling, such as in the car or on a plane. Other conditions may also play a role in the blood not clotting properly. Deep vein thrombosis is associated with leg pain and swelling, generally near the ankle and foot. In some instances of deep vein thrombosis there are no symptoms of leg pain.
Peripheral artery disease (PAD) of the leg is characterized by a constriction or blockage of the blood vessels that extend to the legs. Peripheral artery disease can occur anywhere within the body, but it is most commonly found in the legs. The constriction of blood vessels can occur as the result of atherosclerosis, where fatty plaque builds up within the lining of the arteries. Peripheral artery disease can cause leg pain, particularly in the thigh or calf, during exertion. In many cases, this pain is alleviated while resting.
Given the diversity in the underlying causes of leg pain, it is best to discuss your condition with your physician so as to determine the best available pain management treatment plan. For patients with mild leg pain, that is not placing them at significant risk for impairments in daily functioning, the physician will likely recommend more conservative methods of treatment for the pain.
Pharmacotherapy is one of the more common treatments prescribed for leg pain. Non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, are thought to be so widely utilized because of their ability to reduce inflammation and thereby reduce the associated symptoms of pain. While NSAIDs are widely available over-the-counter, they are associated with some side effects, including gastrointestinal irritation, ulcers, and bleeding. It is generally recommended that NSAIDs be taken for the temporary relief of leg pain and are not recommended in cases of chronic pain, due to the risk of side effects.
Anti-depressants have commonly been used in the treatment of chronic pain and have received some empirical attention. While there is general support for the effectiveness of anti-depressants on chronic pain, there is limited data with regard to their use in patients with leg pain specifically. The most frequently studied class of anti-depressants are tricyclics, such as doxepin, clomipramine, or amitriptyline. Though the complete picture as to why anti-depressants have analgesic properties is not well understood, these drugs are believed to provide relief from chronic pain by blocking the reuptake of the neurotransmitters norepinephrine and serotonin within the neuronal synapse.
Two new classes of anti-depressants that are being prescribed for the treatment of chronic pain are selective serotonin reuptake inhibitors (SSRIs), such as citalopram, fluvoxamine, and fluoxetine; and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine, venlafaxine, and desvenlafaxine. These drugs are sometimes preferred by physicians owing to their favorable side-effect profile of fewer side effects than that of the tricyclics; however, their actual mechanisms of action are not understood. Indeed, it is not clear whether these pain-relieving benefits are unrelated to the anti-depressant effects of the medication. It is likely that patients who have suffered for significant portions of time with chronic pain also develop accompanying feelings of hopelessness, withdrawal, and depression, all of which are relieved along with the symptoms of pain when prescribing SSRIs or SNRIs.
Individuals whose leg pain is severe and has not responded to other remedies, such as over-the-counter medications, may wish to speak to their doctor about a trial of opiods medication, such as tramadol, codeine, morphine, or oxycodone, to help manage the pain. These drugs are particularly helpful in cases of chronic, non-specific leg pain. Their pain-relieving effects arise by binding to the opioid receptors within the brain. Studies have provided ample support for the use of opioids in the short-term relief of sudden onset, severe pain. Side effects of these medications after prolonged use include constipation, dizziness, sweating, and sexual impotence; however, these symptoms tend to fade over time. Concerns regarding the possibility of misuse and abuse of this medication suggest that long-term use of opioids to manage leg pain is contraindicated.
One group of medications that are commonly prescribed for the management of leg pain specifically associated with muscle cramping are muscle relaxants. These medications can be divided into two classes: antispasmodic and antispasticity. Antispasmodic medications, which include benzodiazepines and non-benzodiazepines, act to reduce muscle spasms in the leg and thereby reduce overall leg pain. Antispasticity medications, which include dantrolene and baclofen, act to reduce the spasticity of the muscle and may be beneficial to individuals with leg pain, though limited data currently exists to empirically support its effectiveness.
Botox injections are a form of alternative treatment for managing the symptoms of muscle spasms and the associated symptoms of leg pain. Botox, or purified botulinum neurotoxins, are toxic enzymes produced by the Clostridium botulinum bacteria that have paralytic effects on musculature. Botox is believed to alleviate leg pain by blocking overactive nerve impulses and inhibiting the release of the neurotransmitters that are involved in sensing pain. Several randomized, controlled trials have been conducted on the effectiveness of Botox injections. Findings suggested that pain reduction was achieved at three weeks, and, at eight weeks, ongoing improvements in pain were reported and patients demonstrated overall improved function when compared to placebo controls. More is data necessary to evaluate the appropriateness of Botox injections for the treatment of leg pain.
ome anticonvulsants, such as gabapentin, can be prescribed for the relief of leg pain that is specifically neuropathic in nature. While the mechanisms of action are generally unclear, it is believed that these medications increase the ratio of gamma-aminobutyric acid (GABA) to glutamate. Thus, it may be that their effects on the ion-channel or the enhancement of nonsynaptic GABA accounts for this drug’s pain-relieving qualities. Indeed, more research is necessary in terms of the use of anticonvulsants for leg pain.
It is well known that tension and stress has deleterious effects on the body’s overall health and ability to cope with disruptions. Biofeedback training has received some support for assisting individuals in managing symptoms of chronic pain, and was recently proposed as a complementary treatment for chronic leg and knee pain. This non-invasive, non-pharmacological technique assists patients with recognizing symptoms, thus helping them learn skills to control those symptoms. To do this, the patient is provided real-time information about their physiological processes using psycho-physiological recordings. The biofeedback device is designed to detect very slight changes in the patient’s physiological responses and displays this information to the patient on a computer screen. The intervention includes a number of stress reducing exercises that teach patients how to effect change onto their physiological response system and gain more control over stress. This control also allows them to intervene on the degree of negative effects stress has on their pain condition.
The typical physiological systems recorded during biofeedback sessions include:
During this training, the patient practices altering their internal processes by using a visual representation along with techniques taught to them by trained biofeedback technicians. Additionally, patients are taught relaxation and coping skills, which allows them to feel a sense of control over their pain condition.
Capsaicin skin patches are also believed to provide some relief for leg pain that is neuropathic in nature. Derived from chili peppers, capsaicin binds itself to the nociceptors in the skin, which excite the neurons. Initially, this causes a period of increased sensory sensitivity to itching, pricking, or burning, which is followed by a refractory period of reduced sensory sensitivity. Following repeated applications, the patient can achieve persistent desensitization to pain in the affected area. Evidence has provided strong support for the effectiveness of capsicum over placebo in controlled trials in samples of patients suffering from leg pain associated with sciatica.
Leg pain that arises from the spinal nerves may also be treated by epidural steroid injections. These are administered through the skin to the appropriate location (i.e., epidural spaces) in the vertebrae to reduce pain. To achieve this, the physician will use an x-ray, known as a fluoroscope, to guide the needle that contains the pain-relieving steroid medication. These steroids provide pain relief as they act on the nerve root, which is located within the epidural space. For chronic leg pain associated with the sciatic nerve, a non-surgical nerve block procedure may be recommended to provide patients with significant, and often complete, relief from pain. Located within the buttocks, the sciatic nerve is a bundle of nerves whose job is to transfer pain information from the legs to the spinal cord and brain. Thus, the sciatic nerve block is a non-surgical procedure to anaesthetize the sciatic nerve bundle and thereby prevent the transmission of pain information from the legs. The procedure itself is low risk and minimally invasive. Further, many individuals receiving a sciatic nerve block report immediate and complete relief from sciatic nerve pain, even despite undergoing previously unsuccessful interventions.
Similar to the sciatic nerve block, a sacroiliac joint injection is an interventional treatment available for patients suffering from neuropathic pain. During this procedure, pain-relieving medications are injected directly into the joint to relieve pain. Unfortunately, there are some risks associated with both this and the sciatic nerve block procedure. These include nerve damage as well as inadvertent injection into a blood vessel or into the wrong areas of the spine. This can result in discomfort, loss of sensation, and paralysis in severe cases. Temporary neurological complications such as headache can also occur.
Another minimally invasive procedure is radiofrequency ablation, which involves the insertion of electro-thermal probes near spinal nerves. These probes use a high frequency current to disrupt nerve function, thereby interfering with the nerve’s ability to transmit information regarding sensations of pain from the leg to the spinal cord. The risks associated with radiofrequency ablation are infection, bleeding, and accidental motor nerve damage.
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