I have been gathering lots of information about ALS patients in my country (Japan).I have read atleast 20 cases, their stories and how their symptoms presented from actual patients.Many have different ways of initial symptoms but when they had muscle pain, they were all similar.Ill post on here some of their stories. But its their story, Im just translating it.Case 1: He used to ski alot, but one winter, after a day of skiing, both of his legs hurt so much he couldnt walk down the stairs. He couldnt ski the next day. After that, he couldnt tip toe, he couldnt run at full speed, and these symptos NEVER got better. Later he was diagnosed. (no mentioning of twitches)Case 2: She had shoulder pain for 2 weeks that wouldnt go away, went to her chiropractor and realized that her right hand was bony with no muscle. Later diagnosed. (no mentioning of twitches)Case 3: He started with fasciculations (one of the rare cases). His fasciculation was LOCALIZED at first WITHOUT a hot spot in his right shoulder and arm, but now AFTER A FEW YEARS, its widespread all over his body. Other symptoms followed after a couple of months. His left hand became not weak, but strengthless (if thats even a word). No strength could be applied to that hand. He then asked his friend to massage it for him, but when he did, it hurt so bad he screamed as he pulled his hands away. Thats how bad it hurt. The shower head felt 2 times heavier. He had Babinsky and hyperreflexia. Later diagnosed.Case 4:One summer, he went hiking with his son, but soon after got pain in his legs that woudnt go away for 6 MONTHS. The next year, he couldnt run up hills or stairs when the year before he was doing that daily as his job. (no mentioning of twitches)Others cases Ive read somewhere: the pain is so bad you cant touch it. They cant live without pain killers.Ive looked into many others but these are the ones that had muscle pain.From these experiences, I would say that muscle pain involving ALS is not ordinary pain. Its so painful one cant even touch it.Also, out of all patients Ive read, almost all had twitches after weakness (if they mentioned about twitches at all, since most didnt).And with definite confidence, I could say this. I mean this applied to EVERY patient: almost all patients developed definite symptoms (not the twitches or the perceived weakness or the tingling feeling, I mean real symptoms like not being able to walk for a mile or hold a cup of coffee, those sort of symptoms) within 6 months and ALL, I mean EVERY patient had definite symptoms within a year.Im only 2 months since Ive started having twitches so Im still freaking out. But those of you who have had it for more than 6 months, theres pretty much no chance it could develop into ALS.