How Your Doctor Makes a Chronic Pain Diagnosis

Getting a Chronic Pain Diagnosis May Take Several Visits

Measuring pain objectively is a challenge for healthcare providers, and so coming to a chronic pain diagnosis can be challenging. Everyone feels pain differently, even when the underlying cause is the same. Because of this, being diagnosed with chronic pain is not as simple as making a doctor’s appointment and leaving with a handful of information.

It may take many months to diagnose your chronic pain condition accurately, as your doctor tries to pinpoint the exact cause (or causes) of your pain.

Many chronic pain conditions have symptoms that mimic those of other illnesses, making it difficult to find the true underlying cause. Finally getting a diagnosis may take several appointments, and maybe even a few consultations with specialists.

There are a few things you can expect when you are being diagnosed with chronic pain.

Describing Your Pain

One of the first things your doctor will do is ask you to rate your pain. In fact, patients' self reports of pain are one of the most reliable information sources for a physician. A self report can sometimes help distinguish between neurological pain and muscular pain. Some doctors simply ask questions about your chronic pain, while others may use a more formalized pain questionnaire, asking you to choose the words that best describe your pain (such as burning, tingling, sharp or dull).

In addition to describing your pain, you will be asked how long your pain lasts, what makes your pain worse and what relieves it.

This may include activities, medications or even the weather. It helps to keep a pain journal so that your answers can be as thorough and accurate as possible.

A Psychological Assessment

Don’t be offended if your doctor asks questions about how your pain makes you feel, or whether you have or have ever had anxiety and depression.
There is a high prevalence of depression with chronic pain (and vice versa), and often the two diagnoses can be hard to separate. Anxiety and depression can contribute to your chronic pain, just as having chronic pain can lead to clinical anxiety and depression.

Your doctor may go through formalized psychological questionnaires, or he may simply ask you how you are feeling emotionally. Be as honest as possible, even if you don’t feel you have any psychological issues.

Physical and Neurological Exams

Because your physical structure can sometimes give clues about your ongoing pain, your doctor will give you a thorough physical examination. During this exam, he will check the range of motion in your joints, analyze your posture and look for any physical abnormalities that might contribute to your pain. These include leg length discrepancy, forward neck posture and kyphosis.

Your doctor should also perform a complete neurological exam to check your reflexes, look for any sensory difficulties like tingling or numbness, test your coordination and assess your balance.

These simple tests can expose potential causes of your chronic pain such as muscular weakness, joint sprains and muscle strains.

Blood Work

Though a blood test generally will not tell you the cause of your chronic pain, it can rule out other illnesses that might be contributing to it. Some autoimmune disorders, such as rheumatoid arthritis or lupus, can be detected through blood analysis. Other times, deficiencies or other chronic conditions (such as diabetes) may be the culprit.

If your symptoms seem similar to another chronic disorder, you should expect to have some blood drawn during one of your visits. Depending on what your doctor is looking for, you may have to have multiple tests.

Imaging and Nerve Tests

If your doctor suspects your chronic pain is caused by bone, muscle or nerve damage, he may have you undergo a scan or nerve testing. These include x-rays and MRIs, which can reveal underlying bone and tissue damage. Some other types of testing include nerve conduction tests, which can localize damaged nerves, or EMG testing, which can help pinpoint weak muscles.

Keep in mind that it may take several months for your doctor to pinpoint the cause of your chronic pain. This may mean multiple doctor’s appointments, possible consultations with specialists and even repeat testing as necessary. During this time, your doctor will likely start treating your chronic pain, testing out different types of pain medications and determining what works for you.

Sources:

Brunton, Stephen. Approach to Assessment and Diagnosis of Chronic Pain. Journal of Family Practice, October 2004.

National Institute of Neurological Disorders and Stroke. Pain: Hope Through Research. Accessed 6/13/09. http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm

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