Diagnosing Pain Problems
Pain is not a diagnosis. It is a symptom. It is most important that the pain physician determine the reason for the pain problem. Pain can be caused by a variety of different problems within different body systems, and can affect any of multiple pathways in the nervous system. The pain physician is much like an automobile mechanic, with the task of finding an electrical short-circuit in a car.
Diagnostic tests are designed to determine if the pain is due to mechanical or anatomical abnormalities, or if there is dysfunction in the nervous system. The dysfunction can be at the level of the peripheral nerves, the spinal cord, and/or the brain. All or part of the following list may be needed to make an accurate diagnosis.
1. Complete History– always important
2. Physical Exam– always performed
3. Laboratory– to analyze blood, urine, or spinal fluid. It is sometimes important to sample the chemistry of body fluids to determine abnormalities which might gives hints as to the source of the pain.
4. X-rays, MRI, CT scan, or Bone scan– Various radiological tests can be used to evaluate the patient for anatomical changes of the soft tissues or skeleton.
5. Diagnostic nerve blocks– By turning off the different parts of the nervous system in a specific and selective way, the origin of pain impulses can be evaluated.
6. EMG-NCV– This test measures the function of specific peripheral nerves and muscles. It is performed with tiny needles which are placed through the skin so that electrical activity can be measured. Many diseases can effect either the nerve function or muscle contraction or both.
7. Medication trials– this can be done with oral, intravenous, or spinal medications. The results of these tests can give information about the cause and possible treatment for pain problems.
8. Psychological or Behavioral tests– these test are often misunderstood by the patient or their family. These test are not to see if the pain is imaginary. There is no test for imaginary pain, because there is no such thing as imagined pain. These tests help look for emotional factors which can worsen pain or impede improvement.
9. Functional tests– A variety of tests to measure the patient’s ability to move and function. These tests can be performed by our physical therapist, and can give information toward a diagnosis.
10. Discography– This procedure is a combination of an injection of dye into a spinal disc, and an x-ray picture of the disc as the dye is injected. This test can give information about the source of the patient’s pain which may not be obtained any other way.
The physician should be trained to use every piece of information that is available to determine the most accurate diagnosis. This allows for treatment to be started promptly to relieve suffering.
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