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Diagnosing Chronic Pain

Tests and Procedures for Diagnosing Different Types of Chronic Pain

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Updated April 16, 2014

Chronic pain is usually not diagnosed until you have regularly been in pain for three to six months. This wait can be frustrating when you are in pain without a good medical explanation. Unfortunately, diagnosing chronic pain is not easy.

Because the process of finding a cause for your pain can be daunting, you may be tempted to stop looking altogether. Try, however, to stick with it for as long as you can. Simply eliminating potential diseases and disorders can help you understand where your pain is not coming from, even if the true source is never actually discovered. This can make treating your pain more effective.

Over time, your doctor will perform a number of different tests which may include blood work, imaging and nerve testing. What tests he performs depends on where your pain is located and what he suspects is causing it, in addition to your other symptoms. Here are some of the most common types of chronic pain, and how they are investigated.

Diagnosing Back Pain

If you are suffering from chronic back pain, your doctor will perform tests to determine whether the cause is a tissue disorder, such as a muscle strain or a hairline fracture, or whether it is caused by nerve damage, such as with a ruptured disc.

  • X-rays can detect injuries in bone and dense tissue.
  • MRIs can reveal damage to bones, as well as softer tissues like muscles, ligaments or tendons.
  • CT scans provide more accurate detail than an x-ray, and may be used to examine problems areas more closely.

Diagnosing Headache Pain

Chronic headache pain can be caused by muscle tension, nervous system disorders or eye strain. Frequently, they are associated with other chronic conditions such as MS or neck and shoulder injuries. Your doctor may first rule out any underlying causes of headaches such as disease, chemical abnormalities or dehydration. He may also recommend an optometrist consultation.

If you do not have any underlying disorders which could potentially cause chronic headaches, your doctor may diagnose you by asking a series of questions to determine the cause of your headaches:

  • Is your pain localized on one side of your head?
  • Does it start in the neck?
  • Is it worse at the end of the day?
  • Does it cause sensitivity to light or sound?

The answer to these questions can determine whether you are having migraines, cluster headaches, muscle tension headaches or eye strain.

Diagnosing Fibromyalgia

Fibromyalgia can be difficult to diagnose. Many of its symptoms are common to other chronic illnesses, such as MS or rheumatoid arthritis. If your doctor suspects you have fibromyalgia, you can expect the following tests:

  • X-rays and MRI to rule out tissue disorders.
  • Blood work to rule out rheumatic diseases such as lupus.
  • Neurological testing to rule out MS.
  • Palpation of fibromyalgia tender points.

Your doctor will also inquire about other common ailments associated with fibromyalgia such as irritable bowel syndrome (IBS), difficulty sleeping or concentrating, chronic fatigue and noise or light sensitivity.

Diagnosing Arthritis and Joint Pain

Joint pain is usually caused by arthritis, but repetitive strain injuries such as those resulting from contact sports or manual labor can also cause chronic pain.

When diagnosing the cause of chronic joint pain, your doctor will perform an x-ray or an MRI to examine the tissues and bones in greater detail. He may also perform blood tests to rule out other disorders.

Diagnosing Neuropathic Pain

Pain nerves send signals to the brain when they are stimulated by injury; however they may become overly excitable and transmit signals when it is not necessary. This is the case with reflex sympathetic dystrophy (RSD) and phantom limb pain. Neuropathic pain can also be caused by constant stimulation of pain nerves, such as in cases of slipped discs, narrowing of the spinal canal or injuries that caused severe nerve damage. Peripheral neuropathy is also one of the most common symptoms of advanced diabetes, occuring in 60 to 70% of the diabetic population.

If your doctor suspects your chronic pain is caused by nerves, he will ask you to describe your pain. Most people with nerve pain describe it as burning or stabbing. MRIs and CT scans can pinpoint exact areas of nerve damage. If necessary, your doctor may perform nerve conduction tests to pinpoint areas with damage.

Diagnosing Other Causes of Chronic Pain

Before making a diagnosis, your doctor may want to rule out other, more serious causes of chronic pain. For instance, chronic back pain or headaches may be symptoms of cancerous tumors. Joint pain and fibromyalgia-like symptoms are also common to MS. Neuropathic pain may indicate a mild spinal cord injury.

While it may be frustrating to wait for an accurate diagnosis of your pain, it is best if your doctor is thorough with his investigation. It is better to take your time for the correct diagnosis than rushing into a wrong one, or worse: no diagnosis at all.

Sources:

Malanga, Gerard. ”Diagnostic Tools: X-Ray, Bone Scan, MRI, CT Scan” Spine Universe. 5/7/2004.

Eidelson, Stewart. ”Back and Neck Pain: Diagnosis and Treatment” Spine Universe. 11/23/2004.

Fibromyalgia: The Information and Care You Deserve. American Chronic Pain Association. Accessed December 5, 2008. http://www.theacpa.org/documents/FibroHandbook.pdf

Diabetic Neuropathies: The Nerve Damage of Diabetes. National Diabetes Information Clearing House. Accessed March 3, 2009. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/

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