Without an accurate diagnosis, it’s difficult to find an effective specific treatment for the pain. We use diagnostic studies, physical examination, a detailed history of the pain, (including duration of symptoms, locations of pain, is it in just the back, radiation of pain, muscle weakness, sensory deficit, is there any loss of bladder or bowel control) along with careful evaluation of past medical records, evaluation of past treatments. Past therapies may have included things like non-steroidal anti-inflammatory medications, physical therapy, tensing treatment, opiate pain-relieving medications, anti-depressants, anti-convulsive therapy, and exercise.
With accurate diagnosis, it’s much easier to make an effective treatment plan for pain.
With accurate diagnosis, it’s much easier to make an effective treatment plan for pain. Oftentimes, the patients that have been to our clinic have been to multiple physicians who have looked at parts of the person but don’t take the whole person into account. As pain management specialists, we take a comprehensive approach to the patient. A comprehensive evaluation often yields the answers to complex diagnostic problems that have eluded other clinicians.
Our plan always includes an accurate and detailed history, including history of medications, treatments, diagnostic studies and medical records. We collect the data and assemble a medical database. We have patients complete an extensive questionnaire. We do a physical examination and arrive at a specific diagnosis. If there are additional diagnostic studies that are required such as MRI scan, CT scan x-rays, EMG nerve conduction studies or other studies, we order those and then add the results to the medical database. Injection therapy may be a part of diagnosis of the patients. We can inject different structures, anatomic structures, in the back and with that, help to either rule in or rule out what the pain generator may be.
The concept of the pain generator is a concept that has recently added diagnostic specificity to the field of pain management. The concept is that there are number of structures that can cause pain. Pain generators can be identified and accurately diagnosed by injecting local anesthetic which numbs the nerves and reduces transmission of the pain signals. We can assess whether the injection relieves the pain or not. If it does relieve the pain, then we can tell with certainty that the pain is caused by that structure. If there is no pain relief, then that structure can be ruled out as a pain generator. If there is partial pain relief, then that leads us to believe that that structure may be responsible for some part of the pain but not all of the pain. If there is complete relief of pain then we may well have determined the pain generator.
Accurate diagnosis is the key to identifying a specific and effective plan for treatment of pain.