Often more than one specialist can help diagnose and treat chronic pain. Pain management specialists are medical doctors who specialize in the treatment of ongoing (chronic) pain, such as back pain or nerve pain from diabetes. You’ll want to first work with your family doctor or general practitioner for issues involving pain. If chronic pain is moderate to severe and constant, or if treatment does not control the pain, your doctor may then recommend that you see a specialist. Medical doctors from many different specialties might further specialize in pain management such as:
You will be offered the opportunity to talk in-depth about current symptoms and your medical history. Your doctor may ask questions about when and how the pain started, for a description of the pain, about activities that increase or reduce pain, and current or past treatments. Your doctor will also talk with you about how you are feeling and any medications you are taking. You can come prepared to the appointment with a journal in which you record the type of pain you experience, its severity, duration, when it occurs, what you are doing when it occurs, and what you do to relieve it.
After a complete medical history, your doctor will likely perform a complete physical examination. Furthermore, before doctors can treat pain, they must understand the cause of the pain. In some cases the cause may be obvious, such as a fracture. In cases of chronic pain, the cause(s) may be elusive and make diagnosis difficult. In addition to medical history and a physical, doctors also rely on neurological examinations to make pain diagnoses. Additional diagnostic tools that help to support or rule out a suspected diagnosis include:
CT (computed tomography) scan - This test is a 3-dimensional image used to evaluate bone and soft tissue. Each detailed picture resembles cross-sections of specific areas of the body.
Discography – During this test, doctors inject contrast dye to evaluate intervertebral discs (one or more) via x-ray or ct scans a possible pain source. The test evaluates the structural integrity of the discs and may be used to replicate back or leg pain.
Electromyography (EMG) – An electromyography uses nerve stimulation to measures muscle response and detects muscle damage and disease. An EMG can help differentiate between a muscle and nerve disorder.
MRI (magnetic resonance imaging) – MRIs are commonly used for musculoskeletal evaluation. An MRI provides images in great detail for bones and soft tissues.
Nerve conduction study (NCS) – A nerve conduction study evaluates the speed of nerve impulses as they travel along a nerve to determine if nerve damage is present, the extent of the damage, and if nerves have been destroyed.
Positron emission tomography (PET scan) – When cancer is suspected, a PET scan uses small amounts of radioactive isotopes to measure tissue changes at the cellular level.
Physical exam - A physical examination assesses vital signs such as pulse, respiration, heart beat, blood pressure, and so on. A physical exam for pain may also include palpitation (feeling) or applied pressure to particular parts of the body.
Neurological exam -A neurological exam evaluates the sensory (feel) and motor (function) capabilities including reflexes, balance, ability to walk, muscle strength and muscle tone.
X-ray – An x-ray is a radiograph performed to reveal the condition of the bones. Results may suggest more testing is necessary.
Although there is no definitive test to determine the exact cause of chronic pain, patience and consistency can help you arrive at a diagnosis. Understand that years may pass before a definitive diagnosis is made. During this time, you may seek several other doctors’ opinions for symptoms. However, once a diagnosis is made, you can begin treatment. To learn more about treatment options that can make daily life easier for people with chronic pain, read the next section on How to treat chronic pain for additional information. Plus, which pain medications without a precription can you take?