instruction: hi doctor I am a 45 year old female I was treated with intravenous cortisone injection therapy for a week for having acute demyelinating symptoms for almost two months that appeared together with a new lesion at the cerebellum area of my brain there had been three other there supposedly migraine type lumbar showed oligoclonal zones both in the blood and spinal cord my problem is that since then and even if the cerebellum lesion has disappeared I still experience symptoms not as acute as it had been during the episode but quite annoying to disturb my everyday life I have pain in my left arm and joints left leg and joints of both of my legs I also have back pain and tremor but not always I get tired very easily but tired does not mean tired it means that I start having problems with my balance in the left leg tingling eye sight problem cannot cope with too much noise argues and fights with family gets me worse nobody understands there is something going on the last neurologist I saw said that it is a matter of stress so he suggested to consult a psychiatrist my psychiatrist says stress does not cause this sort of pains as I already get a depression treatment for seven years however let me say they are going to get me crazy with all this do you have any idea how I might proceed
output: hello I read carefully your question and would explain that your symptoms could be related to chronic lesions of multiple sclerosis is sometimes there is no total improvement after steroid therapy anyway I would recommend starting gabapentin for chronic pain or switch from zoloft to duloxetine which is better for chronic pain I would also recommend performing a new brain and spine mri magnetic resonance imaging in order to exclude possible new lesions it is also necessary to check thyearoid hormone levels for possible hormonal imbalance and vitamin plasma levels for possible deficiency I hope this helps