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A 38-year-old woman gave a 2-year history of periodic left anterior thigh pain (figure 1), described as deep and excruciating. It would begin 2–3 days before menstruation. Its numerical rating scale score ranged from 5 to 7/10, rapidly peaked (up to 10/10), lasted 5–6 days and then vanished, with no pain between menses. She had seen various orthopaedic and pain medicine specialists, with a thorough radiological work-up, including lumbosacral MRI with gadolinium contrast (figure 2) and ultrasound scan and MR scan of the abdomen and pelvis, which were all normal. She was diagnosed elsewhere with psychogenic pain and treated with benzodiazepines, selective serotonin reuptake inhibitors and psychotherapy, with no effect.
She was referred for neurological consultation, which she considered ‘the last resort’, before stopping any further medical test or treatment and living with the pain that had ‘no organic cause but came from a wrong state of mind’. On examination, the left patellar reflex was decreased and the femoral nerve stretch test was mildly positive on the left. According to the neuropathic pain diagnostic algorithm, she had probable neuropathic pain (table …
Contributors GZ was responsible for design and conceptualisation of the study, analysis and interpretation of the data, and revising the manuscript for intellectual content. FM was responsible for analysis and interpretation of the data, and drafting the manuscript. ST was responsible for conceptualisation of the study, analysis and interpretation of the data, and revising the manuscript for intellectual content. All authors gave final approval of the version to be published.
Competing interests GZ received travel grants from Grifols and Pfizer for participation in scientific conferences and meetings. FM received travel grants from Grifols and Astellas for participation in scientific conferences and meetings. ST received travel grants from Grifols, Astellas and Pfizer for participation in scientific conferences and meetings. The Institution of ST received money from Pfizer for educational activities on neuropathic pain. The Institution of ST received EFIC Grünenthal Grant 2010.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Carolyn Gabriel, London, UK.