A 35-year-old male presents with severe bilateral burning sensation in both lower limbs, persistent for the past 6 months, significantly affecting sleep, daily function, and work performance. Pain is continuous, non-position dependent, and poorly responsive to all standard neuropathic pain agents tried so far.
He has been evaluated by multiple neurologists. Nerve conduction study and EMG are normal. MRI brain and spine are unremarkable. Vitamin B12 levels normal. No relief with pregabalin, gabapentin, duloxetine, nor tricyclic antidepressants. Psychiatry consultation considered somatoform disorder, but psychotherapy and medications yielded no improvement.
Past medical history includes dyspepsia, currently on regular PPI therapy. On statins for hypercholesterolemia (with strong family history) — lipid profile currently well-controlled. No diabetes, no thyroid disorder, no alcohol or toxin exposure.
Blood investigations, heavy metal screen, porphyria workup, and autoimmune profile are normal. How to go about this case further ??
