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In many people, chronic pain is never diagnosed as a disorder on its own. The underlying condition that is causing the pain may be diagnosed and treated, but the pain may not be adequately addressed. Other people spend years visiting different doctors without receiving either a diagnosis or effective treatment.
Chronic pain may be diagnosed by a pain management specialist. Many pain management specialists have a background in anesthesiology. Conditions that cause chronic pain may be diagnosed by rheumatologists, gynecologists, neurologists, gastroenterologists, and many other types of doctors.
How is chronic pain diagnosed?
There is no one test that is conclusive for a diagnosis of chronic pain. Chronic pain is generally diagnosed through a combination of a thorough medical history and physical examination with the possible addition of other tests.
The doctor will ask questions about the history of your pain symptoms and how pain affects your daily life, including sleep, work, household tasks, and relationships. They may ask questions to determine your psychological state – whether you feel depressed or anxious, your stress level and how you manage stress. They will do a pain assessment to determine your pain level and may ask you to fill out a questionnaire called a pain inventory.
The doctor may perform a physical exam, focusing on the area where you feel pain.
The doctor may perform a neurological exam to check for signs of nerve damage. A neurological exam can include checking the movements of the eyes, measuring reflex responses, and looking for weakness or lack of coordination in the limbs. The doctor may test for loss of sensation by touching various parts of your body with a vibrating tuning fork, or sharp or dull items. The neurological exam provides an objective assessment of signs and symptoms that may indicate a neuropathic condition.
The doctor may perform neurophysiological tests to examine how your nerves function. Electromyography (EMG) involves inserting a small needle electrode into a muscle to record how nerve signals move through the muscle. A nerve conduction study (or nerve conduction velocity test) involves placing patches with electrodes in two spots on your skin. A very low level of electrical current is generated at one patch. The other patch records how long it takes for the signal to travel between the two locations.
Depending on what type of chronic pain you have, you may have already received imaging scans and lab tests. The doctor may review previous test results or order more studies. Imaging procedures include X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) scans.
Blood tests can check overall levels of inflammation by examining erythrocyte sedimentation rate (ESR, or sed rate) and C-reactive protein (CRP). At elevated levels, both ESR and CRP are considered signs of inflammation and can indicate whether an inflammatory condition is likely.