Diagnosis of Chronic Pain

What to Expect at the Doctor's Office

When you are experiencing chronic pain the first step is to try to pinpoint the underlying cause of the pain. Often if the cause can be identified your doctor can more effectively treat your pain.

In some cases no underlying cause of pain is found. When this happens your doctor will focus on managing the pain itself

Medical history
Your doctor will ask you questions about previous illnesses, surgeries, allergies and medications. You will be asked about what treatments have already been tried so that your doctor can figure out what worked and what did not work. You will also be asked to describe your symptoms and to explain what the pain feels like, where the pain is located, what times of the day you feel the pain and what makes the pain better or worse.

Psychosocial evaluation
Your doctor will ask questions to figure out if depression and stress are contributing to your chronic pain. You will be asked about your employment, abilities to perform daily activities and your living situation. It is important for your doctor to understand what your day to day life is like. Your doctor will also ask if you smoke or use alcohol or illegal drugs. Be honest with your doctor. Your doctor needs to know about you as a whole in order to help you.

Physical examination
When evaluating chronic pain your physical examination will focus on your nervous system and musculo-skeletal system. Your doctor will check the motion of your joints, your strength, your reflexes and your sensation. You may be asked to walk back and forth and to complete some simple tasks like getting out of a chair or reaching down to pick up a book. Your doctor will apply pressure to the areas that usually hurt to see if this reproduces the pain.

Lab tests
Samples of blood or urine may be taken from you to figure out if you have an infection that is causing pain. The tests can also evaluate for other illnesses and sources of inflammation.

Imaging studies
Tests such as MRIs, x-rays, CT scans, ultrasounds and bone scans may be ordered by your doctor. These tests can take pictures and figure out if there are physical problems causing the pain.

Electrodiagnostic studies
EMG and NCS may be ordered. EMG stands for electromyography while NCS stands for nerve conduction studies. These tests are usually performed by a physiatrist or a neurologist. EMG and NCV evaluate the electrical activity in your muscles and assess the functioning of your nerves.

Thermography
Thermography evaluates the temperature on the surface on your skin. Some types of chronic pain lead to altered skin temperature. Themrography is a non-invasive way to check for these skin temperature changes.

_Sources:

Tollison et alPractical Pain Management, 3rd Edition

Robinson JP “Chronic pain” Physical Medicine Rehabilitation Clinics of North America 2007 Nov;18(4):761-83, vii.

"Pain: Hope Through Research," NINDS. Publication date December 2001. NIH Publication No. 01-2406