Pain in groin and right leg

[Sandgrounder68]

I am living in the UK. I have been suffering with daily groin pain since a football injury when I was 35. I did have an inguinal hernia op when I was 36 (though no lump) but no effect on pain.

I had 5 relatively good years before 2014. Then pain suddenly started again after playing golf and after having sex and the pain continued for several months. Unfortunately, I ended up with a dvt in that leg, then a pulmonary embolism. Was put on anti-coagulants to deal with this in hospital and thankfully the pain went. I am now on anti-coagulants for the rest of my life.

However, unfortunately the groin pain has suddenly reappeared. I have been in constant pain since early April 2016.

The pain is constant and varies in scale from 4 to 9 out of 10. It can be a stabbing /tearing /burning pain in my right groin where the adductor muscles meet the pelvic bone, going all way down to my knee; sometimes a constant ache also in the right testicle; shooting nerve pain and cramping sensation all way down from adductor muscles down through to the calf muscle; right foot changes colour to purple when standing and feels very cold when compared to left foot. Any kind of activity (walking, etc.) induces pain, especially couple days later. The pain always come on strong about 2 days after any kind of activity.

I am at a loss as to what this could be. Doctors and physios have not come up with any diagnosis. Always get the ‘good news we cannot see anything wrong’ message after any MRI scan! Of course, this is not good news as I desperately am seeking a diagnosis so I can proceed with appropriate treatment.

The doctors advised there’s no new dvt.

Few weeks ago I've had another 3T MRI done in Harley Street and saw dr Marsh at the Gilmore's Groin clicnic. He couldn't help me but recommended a neurologist at the London Clinic (Harley Steet). I'm wating for him to come back to me.

I've also had an EMG done at the NHS but this did not show anything either. I'm having a ultrasound in a week.

Any advice would be much appreciated as I have given up with the British NHS system.

Thanks in advance

[Cardinal]

It might be all myofascial and nerve pain. I'm in the US, but I'd imagine there are interventional pain management doctors there who can do nerve blocks to diagnose if a particular nerve is the culprit. Or, if when you have your pain, if you get a bit of relief upon gently stretching the offending muscles or taking a good muscle relaxant like xanax or valium, then I would guess the muscles are the issue. It could be that activity caused muscle tension and/or trigger points and they are impinging on pelvic nerves (some nerves go from pelvis down leg too). But I don't think it would cause change in color of your foot - that sounds more like a vascular issue. Maybe you have two separate issues and they happen to be in overlapping areas. I wish you my best.

[Sandgrounder68 in reply to Cardinal]

Thanks very much for your reply. Much appreciated.

I have recently been learning all about myofascial and trigger points in "A Headache in the Pelvis" book! Certainly, this book has helped me also too on trying to be positive and not to detach myself from my right leg, which I have been guilty of.

Agree that nerve blocks is one way of diagnosing the culprit. Though nervous of this. Any other scans - I was thinking dynamic MRI or even MR neurography?

I was on valium, but my doctor has refused to let me have anymore! As told addictive. Am taking Gabapentin - now 900 mg daily but with only marginal affect.

Kindest regards,

Paul

[Cardinal in reply to Sandgrounder68]

You would likely need to be on a much higher dose of gabapentin to feel a benefit (unless you are really sensitive to it). I actually took 3,000mg and felt no difference. Most people with pelvic nerve pain take between 1800 and 2600 mg of gabapentin. Most say it takes the edge off the pain. Xanax really helps my myofascial pain, but the problem is it makes me sleepy, but others don't have that problem. I take methadone, and that helps the most and with little side effect.

Yes, I've heard of others getting MRNs. There seems to be debate on whether pelvic nerve entrapments can actually be found on them, but I say, if it's free (for yoi) and not much trouble, you may as well get it. There is, I guess, a "special" MRI that a couple radiologists in America do where sometimes they are able to see a nerve entrapment. One in Arizona and one in New York. But it's still questionable.

If you go to pudendalhope.info website, there is some info on diagnosing pelvic nerve pain and a list of doctors that specialize in the area. And physiotherapists, as well.

[Sandgrounder68 in reply to Cardinal]

Cheers, this is very informative. Thank you. I certainly will be looking pudendalhope.info website. Had a quick look but this will be very useful indeed.

Xanax is a benzodiazepine, like diazepam so my GP will say 'no' to that unfortunately. Certainly, methadone is an idea. It's a stronger opioid than codeine phosphate, which I currently take (for severe pain - doesn't help much). I may have to do something like that if pain increases further but bit reluctant to take opioids long term. However, when the pain is bad guess there is no choice.

Thanks for the tip on gabapentin. I will keep increasing the dosage!

[Desperateforrelief]

I have obturator and pudendal neuralgia. The groin pain and pain down the left inner thigh (is that where it is?) is obturator neuralgia. The pudendal nerve and obturator nerve are very close to each other as is the sciatic nerve. A neurologist is the best place to start. You can read about these on pudendal hope website. Stabbing, tearing, burning pain is a sign of nerve damage/compression. Your symptoms are overlapping with pudendal neuralgia symptoms. But if you can sit with no issues it's probably not the pudendal nerve. I know more about this than I ever wanted to know, suffering is not fun! So sorry you're suffering. Since the sciatic nerve is so close to the pudendal nerve it is sometimes impacted when the pudendal nerve swells and that is what has happened to me. It causes pain down my leg and even into the arch of my foot which spasms. My doctor said that was the sciatic being irritated. I hope this helps some.

[Desperateforrelief in reply to Desperateforrelief]

P.S. I also agree with reply above. These are all inter-related. I have found that a mixture of lidocaine-flexeril-valium has helped me tremendously.

[Sandgrounder68 in reply to Desperateforrelief]

Thanks for your reply and very useful. Yeah it's on the inside, i.e. right inner thigh for me. I find sitting ok, worse for me is if try to lie down, with upper torso perpendicular. Stopped doing that as get awful nerve pain.

Any position after some time starts to cause me issues. And attempting to lie down on a hard slab for x-ray/mri etc is a nightmare as leg is just so tight.

[Pepper1977]

Have your ilioinguinal and saphenous nerve evaluated. Google Dr lee dellon and read his free online chapters. There is a dr Aszmann in Vienna as well.

[Sandgrounder68 in reply to Pepper1977]

Cheers, thanks for the reference to this website dellon.com/free-booklets.html. Added to my favourites - lots of reading to do