Exams and Tests to Diagnose Chronic Pain
Diagnosing chronic pain can be a long process. As you can learn in the article Causes of Chronic Pain, there are many possible causes, so the doctor will run various exams and tests to try to figure out your pain.
Here are some of the ways the doctor may try to diagnose your chronic pain.
Your doctor will take your detailed health history. You'll go over illnesses, any injuries, and medical problems that run in your family. Because chronic pain can develop following illness or injury, it's important to be thorough so the doctor can look at the full range of causes.
You'll also have to be very specific about your pain: description, intensity, frequency, duration, activities that make it worse, if it's better at a certain time of day, etc. If you don't already do this, it might be a good idea to start a pain diary where you record details of your pain. Then you'll be better able to share information with your doctor.
Physical, Neurological, and Mental Health Exams
For the physical exam, the doctor will observe your range of motion (that's how well and how far you can move certain joints), posture, and general physical condition. He or she will make note of any movements that cause or increase your pain.
The neurological exam will test your nerves, so this exam is particularly crucial in chronic pain. The doctor will test your reflexes, muscle strength, and how well you can feel. For example, the doctor might test if you can feel a very light touch on your skin. If you can't, that may indicate nerve damage. The doctor will also see if your pain is spreading to other parts of your body during the neurological exam—did you come in complaining of back pain but find that sometimes, you have pain in your leg, too?
Because chronic pain often has an emotional or psychological component, you may need to have a mental health exam. This is to check for symptoms of disorders, such as anxiety or depression, that can develop alongside chronic pain. The mental health exam will also give your doctor a more complete picture of your overall health.
To see if there's an injury or identifiable condition causing your chronic pain, the doctor will need to run diagnostic tests. For the imaging tests (x-rays, MRIs), you may have to go to an imaging center to have these done; the results will be sent back to your doctor, who will interpret them for you.
Some possible diagnostic tests are:
- Blood test: The doctor may be able to tell if you have certain types of arthritis or an infection based on a blood test. These conditions can lead to chronic pain. A blood test also allows the doctor to check your liver and kidney functions.
- Bone scan: To help your doctor detect spinal problems such as osteoarthritis, sacroiliac joint dysfunction, fractures, or infections (which can all lead to chronic pain), you may have a bone scan. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity—such as an inflammation. A scanner can detect the amount of radiation in all your bones and show the "hot spots" (the areas with more radioactive material) to help your doctor figure out where the problem is.
- CT scan: A CT scan, which stands for computerized axial tomography, shows the bones, but it also shows the soft tissues and nerves.
- EMG: An electromyography (EMG) will test if your muscles are responding well to nerve stimulation.
- MRI: An MRI, which stands for magnetic resonance imaging, shows the bones, but it also shows the soft tissues and nerves. MRIs don't expose you to radiation; they get their image by using magnets.
- Myelogram: To see if you have a spinal canal or spinal cord disorder—perhaps nerve compression causing pain and weakness—you may have a myelogram. In this test, you'll have a special dye injected into the fluid that surrounds your spinal cord and nerves. Then you'll have an x-ray or a CT scan. The image will provide a detailed anatomic picture of your spine, especially of the bones, that will help your doctor to identify any abnormalities.
- NCV: A nerve conduction velocity (NCV) test will help the doctor evaluate your nerves and determine if there's any damage. This test is usually done together with the EMG test.
- Nerve block: If the doctor suspects that a certain nerve is damaged and that's what's causing your chronic, he or she may do a nerve block. This is a special type of injection that may help identify if the nerve is the source of pain.
- X-ray: This gives your doctor a clear picture of your bones.