Diffuse erratic pains

Specialty: General.

• migratory body pains
• erratic painful discomfort
• non-joint migratory pain

Why it occurs

• Vasculitis of small or medium vessels (such as polyarteritis nodosa or granulomatosis with polyangiitis, where intermittent tissue ischemia causes pain in different territories)
• Somatization disorder or fibromyalgia in the phase of high peripheral reactivity (alteration in the modulation of central pain that causes changing pain in location)
• Parasitic tissue infections by nematodes or cestodes in the larval migration phase (trichinosis, gnathostomiasis, causing local and systemic migratory myositis)
• Delayed drug hypersensitivity reactions or serum sickness (deposition of floating immune complexes in muscle capillaries and fascia)
• Subacute infective endocarditis with repeated peripheral microembolisms in different muscle or bone territories.

Initial workup

Serial blood cultures, high-resolution transthoracic echocardiogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), immunological panel (ANA, ANCA, rheumatoid factor), and eosinophil count in peripheral blood (essential for migratory parasitosis).

Standard management

• Ibuprofen — 400 mg orally every 8 hours for a maximum period of 5 to 7 days, with gastric protector
• Pregabalin — 75 mg orally in the evening to stabilize nociceptive signals if a neural sensitization component or migratory neuropathic pain is suspected
• Omeprazole (20 mg orally once a day in the morning for gastroprotection if NSAIDs are used regularly).