Bone pain returns

I have grappled time and again with bone pain. The worst episode lasted almost a year around 2010 and I found the answer after numerous trials and errors, seeing multiple specialists and a lot of frustration. The balance between drugs and the Calcium level in the dialysate is very delicate and I have never quite found the right answer.

For the last month or so, I have felt the pain return. The signs were familiar. The back first started to hurt. Then a shoulder. Now the feet. The increase was gradual. A month back, I found that my PTH had plummeted to 30 pg/ml (it should be around 250). I immediately stopped the Calcitriol and Cinacalcet (after confirming with my nephrologist). However, the pain continued to increase.
From this Sunday, however, things became quite severe. I am now walking with a limp.

I checked my PTH again to see if I was on track. 150 pg/ml. Ok, I was on the right track. Not there yet but getting there hopefully.

But then, why did the pain worsen?

Currently, my right shoulder aches unbearably during the last hour or so of dialysis. It returns in bursts during the day causing a lot of discomfort. And my left foot continuously pains. I am actually wondering if there is a tear or a small fracture of some sort!

My Calcium and Phosphorus levels are normal. So, is my Vitamin D.

I have scheduled an appointment with my nephrologist tomorrow. I hope he has some answers.