CHALLENGING CASE: see question details for case.

[EmmaT37]

CHALLENGING CASE: 30 year old Armenian female with severe leg pain & restlessness
Hello I suffer from chronic aching legs since childhood. Character has changed over time. After having my son 2 years ago, the bilateral thigh pain portion has significantly worsened. Every time my entire legs hurt, they are always cold to touch. I also suffer from severe Restless Legs Syndrome. I wake up every night at 2-3 AM and am either restless or in pain, or both, staying awake for several hours sometimes unable to sleep. In mornings, I have associated heaviness and pulling tired sensations. I have fatigue, probably secondary to the insomnia. I require Norco 10/325 QID and even that is not sufficient for full relief. EMG/NCS negative. MRI brain, back, knee/patellofemoral region or pain negative, X-RAY or legs negative, venous/arterial ultrasound with ABI are both negative. Major lab testing all inflammatory markers all negative but I’m suffering very bad and this has taken over my life causing bad major depression. I’ve seen 3 Neurologist, 2 Rheumatologist, Cardiovascular, Cardiologist, and Neuromuscular Neurologist (whom diagnosed me with POTS, explains my syncopal episode 5 years ago and near syncopes when all findings in ER pointed to vasovagal). Ive tried flexeril, lorzone, most NSAIDs, 2 shots of steroid, gabapentin, lyrics- all ineffective. Please, any advice to even try?