From the Guidelines
For a patient presenting with generalized musculoskeletal pain and paresthesia in the arms, back, and legs, the recommended blood tests include creatine kinase (CK), transaminases (AST, ALT), lactate dehydrogenase (LDH), aldolase, troponin, inflammatory markers (ESR and CRP) as per the American Society of Clinical Oncology clinical practice guideline 1. When evaluating a patient with these symptoms, it is crucial to consider a broad range of potential causes, including inflammatory and autoimmune conditions.
- The initial blood workup should focus on assessing muscle inflammation and damage, as indicated by elevated levels of CK, AST, ALT, LDH, and aldolase 1.
- Inflammatory markers such as ESR and CRP are also essential to evaluate the level of inflammation in the body 1.
- Troponin levels should be checked to assess for any myocardial involvement 1. Additionally, considering the patient's symptoms of electric shock pains, it is vital to rule out any underlying neurological conditions that may be contributing to these symptoms.
- Further testing, such as electromyography (EMG), imaging (MRI), and/or biopsy, may be necessary on an individual basis if the diagnosis remains uncertain or if there is suspicion of overlap with neurologic syndromes 1.
- Paraneoplastic autoantibody testing for myositis and neurologic conditions, such as myasthenia gravis, should also be considered 1. It is essential to note that the diagnostic workup should be tailored to the individual patient, taking into account their complete medical history, physical examination findings, and any preexisting conditions that may be contributing to their symptoms 1.
From the Research
Blood Tests for General Aches and Pains
To diagnose and monitor generalized musculoskeletal pain and paresthesia (electric shock pains) in the arms, back, and legs, several blood tests can be recommended. These tests help identify underlying inflammatory conditions that may be causing the symptoms.
- Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) are commonly used markers of inflammation 2, 3, 4.
- ESR is helpful in monitoring chronic inflammatory conditions, while CRP is more useful in diagnosing acute inflammatory conditions and monitoring responses to therapy 2.
- It is essential to understand the factors that can affect ESR and CRP levels, such as noninfectious conditions, resolution of inflammation, and physiological factors like renal disease, female sex, and older age 3, 4.
- Vitamin D deficiency has been linked to various health conditions, but its relationship with inflammatory markers like ESR and CRP is still being researched, with some studies finding no direct correlation 5.
Additional Considerations
When interpreting the results of these blood tests, it is crucial to consider the clinical context and combine the findings with a thorough clinical history and physical examination 3.
- The choice of blood tests may depend on the suspected underlying condition and the presence of other symptoms.
- In some cases, additional tests like leukocyte count or measurements of plasma 25 hydroxy vitamin D3 levels may be necessary to rule out other conditions or to monitor the patient's response to treatment 5.
- For patients presenting with acute pain, pharmacologic management options like acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and topical NSAIDs may be considered, depending on the severity and nature of the pain 6.