Ultimate Guide: Understanding Chronic Pain | Part 2

Chronic Pain - The Ultimate Guide. Many chronic pain patients are misdiagnosed. I want to help you make sure that you are diagnosed properly. Part 2 of the guide will help you to understand what you should expect from a comprehensive chronic pain assessment. It provides information on what doctor you should see first, different biological mechanisms of pain, relevant symptoms & family history, possible diagnosis list, categories of pain conditions, physical examination, testing, specialist referrals & pain clinics.

The Ultimate Guide To Understanding Chronic Pain | PART 2

 

The purpose of this guide is to provide you with a solid foundation of knowledge about chronic pain so that you can understand your chronic pain better & then, in turn, manage it better.

Knowledge is power. This is why it is so important for you to be an informed patient.

The uncertainty, which living with chronic pain brings, often leads us to feel hopeless & helpless. Knowing that there is no “cure” only strengthens those feelings.

But, I learned on my own chronic pain journey, that there ARE things that we can do to help our bodies heal. I have been gathering gold nuggets of knowledge & insight that I want to share with the chronic pain community via this blog.

As I kept learning about new ways that I can be pro-active about helping myself heal, the sense of hopelessness & helplessness began to evaporate. It was replaced by renewed hope and inner strength – my new found understanding of chronic pain began to help me feel empowered. You can read some of my chronic illness & chronic pain story here.

I am not promising overnight healing or even complete healing for that matter.

What I am proposing is a promise that we make to our own selves – a promise to never give up on our health.

Despite the fact that many of us have been told that there is no cure, and most certainly no magic pill, for our chronic illness’, including chronic pain, I pray & wish for each one of us to have the inner strength to keep putting one foot in front of the other. Because if we ourselves do not strive to keep fighting for our health, then who will?

Ultimately WE hold the power.

With so much going against us, such as denied disability claims, unsupportive employers & treatments that don’t work, to name a few, it is far easier to just give up.

But we don’t. We choose to be WARRIORS instead.

So let us channel our limited supply of energy into a lifestyle of healing.

Many chronic pain diagnoses, including fibromyalgia, are misdiagnosed. Find out everything you NEED to know so that this does not happen to you. Learn about relevant symptoms & family history, list of possible diagnoses, specialist referrals, illness categories, testing and more.

(c) 2018, STRIVETOHEAL.COM

Future parts of this guide will go into details of how interconnected our pain experiences are to all aspects of our life. In order to keep striving to heal, all aspects of pain need to be targeted. As my pain specialist once told me, let’s throw everything at it….well, not literally everything, just the stuff that has a leg to stand on.

There will be no hokey-pokey ‘cures’ on this blog – only solid advice that has scientific merit. I have a strong science background & a critical eye for information.

If you haven’t yet read PART 1 of this guide, check it out to get a good understanding of what is chronic pain, what are the different types of chronic pain and what are the differences between acute & chronic pain.

PART 2, which is what you are reading right now, covers chronic pain assessment. It is very important that you have an accurate diagnosis.

Many chronic pain patients end up being misdiagnosed at some point in their healing journey. Unfortunately, this can lead to worsening symptoms, including an increase in pain, and obviously a delay in proper treatment.

I want this part of the guide to help you receive a more timely and correct diagnosis.

PART 2 of the guide includes a FREE 7-page printable Medical History & Symptoms form and checklist that is especially useful for your initial appointments with specialists. There is a sign-up window for this printable further down below.

This form and checklist will help you to document relevant chronic pain symptoms and family history findings when you attend doctor appointments. It also provides a body diagram for you to document different pain types and sensations that you can experience with chronic pain.

(c) 2018, STRIVETOHEAL,COM

 

PART 1 of the guide covers:

  • What Is Chronic Pain?
  • What Are The Different Types of Chronic Pain?
  • Acute Pain vs. Chronic Pain

 

PART 2 of the guide covers:

  • Chronic Pain Assessment
    • Which Doctor Should I See First For My Chronic Pain?
    • Determine The Pain Type(s)
    • Your Medical & Family History
    • Physical Examination
    • Testing
    • Arriving At A Diagnosis
    • Specialists
    • A Word On Pain Clinics
    • We Are Not “Doctor Shopping”

 

Chronic pain conditions are difficult to diagnose properly. Find out why, and what you need to know to make sure that this does not happen to you. Learn about relevant symptoms & family history, underlying causes, possible diagnoses, tests and specialist referrals. Part 2 of the Ultimate Guide To Understanding Chronic Pain will help you to make sure that your chronic pain is evaluated and diagnosed correctly.

Chronic Pain Assessment

Treating pain and the underlying causes of your pain symptoms early on can help prevent or lessen the impact of pain chronification changes that occur once chronic pain sets in. Because once pain chronicity takes place, the pain is a lot more difficult to treat (1).

This does NOT mean that it is too late to start treating your chronic pain. It may take more determination, time and focus on your part, but it is not impossible.

Unfortunately, as you probably know first hand, too many chronic pain patients fall through the cracks and do not receive prompt treatment, proper treatment or even enough medical consideration for their symptoms.

But, it is very important that you have an accurate diagnosis because it will determine your treatment.

However, chronic pain patients are a challenge to diagnose properly for a number of reasons.

  • Many chronic illnesses have chronic pain or chronic widespread pain (CWP) as a symptom (2).
  • To complicate things, many chronic pain patients have more than 1 type of pain and suffer from more than 1 chronic pain condition (2, 3).
  • To make things even more challenging, many chronic illnesses have chronic pain AND these other symptoms in common (2, 3, 4):
    • Fatigue
    • Poor sleep quality
    • Anxiety &/or depression
    • Brain fog or cognitive difficulties
    • Body stiffness
    • Muscle weakness
    • Swelling
    • Soft tissue or body tenderness
    • Poor quality of life
    • Difficulties with activities of daily living
  • In addition, there are some conditions that lack awareness even amongst the medical community or perhaps the diagnoses criteria have been updated (for example Ehlers-Danlos Syndrome) and the doctors you are seeing are only familiar with outdated information. Or the medical condition is quite rare & isn’t even on the doctor’s radar.
  • Also, individual patients suffering from the same root cause can experience different symptoms.

So the reality is that many of us end up being misdiagnosed & it can take months and sometimes even years to have our medical issues properly sorted out.

Many chronic pain conditions, such as Fibromyalgia, are often misdiagnosed. Part 2 of this guide provides important information for your chronic pain assessment. It includes details on relevant symptoms, list of possible diagnoses, pain types, physical examination, testing, specialist referrals & pain clinics.

(c) 2018, STRIVETOHEAL.COM

 

We truly are a challenging and complex group of patients.

Even when you start receiving thorough and comprehensive medical care, do not expect to have a diagnosis and treatment plan in place right after your first appointment.

Because dealing with chronic pain tends to take you on a journey – visiting various specialists, undergoing different tests, and trialing different treatment types. It is like putting together pieces of a puzzle.

This section of the guide will help you determine if you are receiving a good medical evaluation for your chronic pain.

Which doctor or physician should you first seek help from if you suffer from chronic pain? The best place to start is with your family physician, general practitioner (GP) or primary care doctor. Find out what you should expect from a thorough & comprehensive chronic pain assessment so that you reduce your chances of misdiagnosis. Because, unfortunately many chronic pain patients do end up being misdiagnosed.

WHICH DOCTOR SHOULD I SEE FIRST FOR MY CHRONIC PAIN?

If this is the start of your healing journey, it is best to first make an appointment with your primary care provider or general practitioner/family physician.

This doctor may become your primary physician that oversees your chronic pain management. Or, further down the road, you may find another physician or even clinic, that will oversee your medical care.

No matter what physician you see, the goals of their assessments should be:

  • to determine your pain types
  • to determine if your medical &/or family history has clues as to what could be the underlying cause(s) of your medical issues
  • to provide a thorough & detailed examination of your body
  • to determine which, if any, testing could shed light on your symptoms
  • to determine if you require specialist referrals
  • to confidently provide a diagnosis or at least rule in or rule out disorders or illness categories ( e.g. autoimmune, musculoskeletal)
  • to determine what type of treatment(s) would be most appropriate for you

 

To receive a correct chronic pain condition diagnosis, the different biological mechanisms of your pain need to be identified. These include nociceptive pain, inflammatory pain, somatic or musculoskeletal pain, visceral or organ pain, nerve or neuropathic pain. Your doctor also needs to assess if you are experiencing acute, on-going prolonged acute or chronic pain.

(C) 2018 STRIVETOHEAL.COM

DETERMINE THE PAIN TYPE(S)

The physicians you see need to determine if you are suffering from untreated acute pain or ongoing chronic pain (5).

It is also important for the physicians to determine which biological mechanisms are causing your pain, as your treatments will depend on the type of pain that you are experiencing.

To recap the What Are The Different Types of Chronic Pain section from PART 1 of this guide, chronic pain is usually divided into the following categoiries:

SOMATIC PAIN

  • nociceptive pain originating in the skin, muscles, joints, tendons, ligaments, bones or body wall
  • inflammation may be present & you can experience additional pain because of it
  • superficial somatic pain can feel sharp, throbbing, pricking or burning; It occurs in the skin and mucous membranes
  • deep somatic pain can feel sharp or dull, like a deep ache, cramping or gnawing

VISCERAL PAIN

  • nociceptive pain originating in the internal organs
  • inflammation may be present & you can experience additional pain because of it
  • it often feels like a deep squeeze, ache or pressure; it can be diffuse

NEUROPATHIC PAIN 

  • pain is caused by injury, irritation or dysfunction of the peripheral or central nervous system
  • it can feel electrical, numb, tingling, burning, radiating, shooting, stabbing, knife-like or toothache-like

Check out PART 1 of the guide to read more detailed information on the different types of chronic pain.

 

Remember that you are likely experiencing different pain types at the same time, especially if your chronic pain has gone on for some time (2, 5).

 

If you suffer from chronic pain syndrome, or any of the chronic pain conditions, such as fibromyalgia, arthritis or endometriosis etc, there is a long list of relevant symptoms and family history findings that are very important to identify. Check out what symptoms & family history is relevant to bring up during your chronic pain assessment.

YOUR MEDICAL & FAMILY HISTORY

It is very important that you are given the time to provide a full medical history.

Many chronic pain patients have trouble finding physicians that will make the time for their long list of sometimes perplexing complaints. My hat goes off to all the doctors who take us on & have a vested interest in figuring out our health troubles and how best to treat them.

If my own primary care physician wasn’t willing to spend at least 1 hour, many times longer, on almost every single appointment with me, I know that my recovery would have been impacted negatively.

Below you will find a long list of information and symptoms that you should include during your initial appointments with the various physicians you see. From my experience, specialist clinics like chronic pain clinics, sleep clinics or mental health clinics, tend to use a formal more in-depth questionnaire, but that is not always the case.

And sometimes, for whatever reason, doctors simply don’t ask about some symptoms, even though they could be relevant, and this potentially significant information falls through the cracks and takes you along with it.

There could be symptoms that you may have noticed, but simply shrugged off thinking that they would not have anything to do with ANY medical issue.

This list also gives you food for thought and will help you to notice relevant symptoms, that you have never paid attention to before.

I wish that I would have had such a list when I first sought medical help when my chronic pain became severe. Read about some of my chronic pain & chronic illness story here.

I prepared an awesome (well, at least I think so 🙂 but make sure to let me know what you think in the comments section!) form and checklist that captures a lot of relevant information when you suffer from chronic pain. I would have loved to have something like this at the beginning of my chronic pain journey when I was preparing for doctor appointments…..especially the initial specialist consultations.

Subscribe to strivetoheal.com and receive your FREE 7-page printable Medical History & Symptoms form and checklist!


Knowing about the symptoms below will help doctor(s) determine your proper diagnosis & what testing and specialist referrals you may need (2, 6, 7, 8):

  • family medical history of similar issues or any of the symptoms from below
  • were it hurts and what the pain(s) feels like
  • when the pain developed
  • how the pain has evolved
  • abnormal pain response (e.g. pain from gentle touch, severe pain with a minor injury)
  • what makes your pain better or worse
  • if your pain is aggravated by weather changes, tension, poor sleep, stress
  • what makes your other symptoms better or worse
  • difficulties with sleep (falling asleep, staying asleep, light sleep, early awakening, poor sleep quality)
  • fatigue that does not get better with sleep
  • brain fog (trouble with: concentrating & finding words, poor memory, problem-solving, reading comprehension)
  • weight loss or gain
  • reduced or increased appetite
  • fever
  • abnormal sweating
  • dry mouth
  • if you experience morning stiffness and how long it takes to improve
  • general body stiffness
  • if your fingers, legs or toes get discolored (white, blue, purple or red)
  • rashes
  • easy bruising
  • fragile skin – tears or splits open easily, stitches tear out, takes longer to heal
  • soft, velvety or silky skin
  • scars that look like parchment paper or cigarette burns, unusual scarring, widened scars, scars that are sunken below the surface of the surrounding skin
  • fleshy scars or fleshy skin over pressure points (e.g. fingers, elbows, knees, chin, forehead)
  • small movable cysts under the skin
  • excess stretch marks
  • stretch marks during adolescence that are not associated with rapid weight gain
  • minimal or non-existent stretch marks during pregnancy even with significant rapid weight gain
  • increased wrinkling of palms
  • abnormal skin sensations (e.g. more sensitive, numbness)
  • arachnodactyly (long and slender fingers/toes)
  • mechanic’s hands – thickened, rough, chapped, cracked skin on tips and sides of fingers or palms resembling those of a manual laborer
  • hiker’s feet – thickened, rough, chapped, cracked skin on toes, heels, and/or balls of feet
  • white looking nodules under the skin just above soles of feet while standing
  • foot deformities
  • sun sensitivity
  • noise, smell and/or light sensitivity
  • any bowel symptoms (diarrhea, nausea, bloating, constipation, blood in stools, abdominal pain & cramping)
  • acid reflux, heartburn
  • slipped/herniated/prolapsed disks
  • very flexible or double-jointed even as a child
  • if you could ever place your hands flat on the floor without bending your knees
  • if you could ever bend your thumb to touch your forearm
  • if you could ever do the splits
  • repeated sprains and/or joint dislocations (full or partial) especially shoulder, knee or ankle
  • fractures with minimal trauma
  • recurrent jaw pain, clicking, locking, popping
  • other injuries to joints, ligaments, tendons or other soft tissues around joints
  • early onset osteoarthritis
  • scoliosis
  • increased body/joint pain with ovulation or menstruation
  • heavy and painful menstruation
  • musculoskeletal and/or pelvic complications in pregnancy
  • painful intercourse
  • pain with fine motor tasks or repetitive tasks (e.g. handwriting, using utensils)
  • clumsiness (e.g bumping into things)
  • poor response to local anesthetics (e.g. dental procedures, freezing prior to epidural)
  • early onset recession of the gums (childhood, adolescence)
  • dental crowding
  • high or narrow palate (roof of the mouth)
  • early onset of varicose veins (under age 30 especially if a woman has not had children)
  • ruptured blood vessels (e.g. aneurysm) or organs
  • heart valve disease
  • hernias
  • organ prolapse (organs drop out of position)
  • hemorrhoids
  • blue discoloration of the sclera (white of the eye)
  • eye lens or retinal detachment
  • cataracts
  • abnormal cornea
  • astigmatism
  • myopia (nearsightedness) – poor long-distance vision
  • glaucoma (increased pressure of the eye)
  • hearing loss
  • recurrent fainting or feeling that you will pass out (e.g. with prolonged standing)
  • heart palpitations (increased heart rate) and/or lightheadedness when go from lying to standing
  • slow or fast heart rate at rest
  • high or low blood pressure
  • over-sensitivity to temperatures
  • exercise intolerance
  • chest pain
  • dizziness
  • balance issues
  • delayed gross motor skills as a child (e.g. crawling, walking)
  • delayed fine motor skills as a child (e.g. writing, zipping, using fork/spoon, buttoning)
  • persistent “growing pains” as a child
  • learning disabilities
  • childhood trauma, abuse (physical or emotional) or high levels of stress
  • current trauma, abuse (physical or emotional) or high levels of stress
  • anxiety, panic disorder, depression
  • current & past medications
    • dosages
    • effect on symptoms
    • any side-effects
    • correlation between the start of medication and new or worsening pain/symptoms within 1-2 months
This form & checklist will help you to document relevant signs and symptoms in your medical and family history that relate to the many different chronic pain conditions, such as fibromyalgia, rheumatoid arthritis, osteoarthritis, Ehlers Danlos, Lupus, Lyme disease, SI dysfunction, endometrioris, irritable bowel syndrome (IBS) and migraines. Use this form to reduce your chances of being misdiagnosed with a related chronic pain condition.

(c) 2018, STRIVETOHEAL.COM

An in depth physical examination is an important part of a chronic pain assessment. Find out if you are receiving good medical care for your chronic pain complaints & if your chronic pain symptoms have undergone a comprehensive examination.

PHYSICAL EXAMINATION

Any physical examination you have needs to be thorough.

However, it can be tricky for a patient to gauge if the physician is being thorough because different doctors can use different assessment tools and tests, even when they are assessing for the same condition. But once you go through a few physical examinations, you will be able to get a sense of how much effort the physician is putting in.

Here are some tips on what you should expect (2). Keep in mind that depending on the specialty of the doctor you see, the physical examination could vary.

  • full physical examination with particular attention to areas of complaint
    • checking for swelling, redness, rash, deformity, range of motion (ROM), stiffness
  • an attempt at reproducing the pain
  • assessment of
    • eyes
    • body tenderness
    • trigger points
    • tender points
    • muscle spasm
    • normal walking (gait)
    • heal and toe walking
    • balance
    • muscle strength, tone, shape
    • reflexes
    • abnormal sensations
    • lymph nodes
    • skin hyperelasticity
A comprehensive assessment of chronic pain symptoms should include a thorough physical exam. You could be experiencing more than 1 pain type and more than 1 pain condition at the same time, and all root causes of your chronic pain symptoms need to be investigated.

(c) 2018, STRIVETOHEAL.COM

In my experience, some doctors seem to think that a gentle prodding here and there, without re-creating pain means that there is no evidence of tenderness or of that area being a pain generator. Even though the tenderness or pain is there…..it’s always there…..they just didn’t do a good enough job of finding it.

Then there are the doctors who don’t bother doing anything about your complaints except giving you sick notes. Sometimes they don’t even bother directing you to someone who could help you.

Some doctors are very arrogant and condescending and totally convinced that they have nailed your diagnosis & take offense if you try to ask questions or attempt to have a discussion regarding your care. They may cut you off as you are trying to tell them relevant information, and then bluntly tell you that your appointment is finished and that you should gather your things and leave.

Some doctors are thorough and open minded to questions or discussions and it would be great if they could be involved in your medical care….except that they just don’t have the time for a high need patient like you.

I have experienced all of these scenarios and more.

If a doctor is cutting you off, rushing through your appointment or is not interested in really hearing your story, then that is NOT a good sign.

If the doctor barely, or maybe even not at all, checks over your body, then that is NOT a good sign.

If the doctor expects you to sit quietly and only LISTEN to what THEY have to say, then that is NOT a good sign.

Listen to your gut. You will feel it when your concerns are being dismissed, minimized, or overlooked. It probably means that this particular medical appointment has been a waste of time and money and that you will need to keep pushing forward.

Doctors with good bedside manners & excellent clinical skills DO exist. Do not give up on finding a good physician because they will be your ally in your chronic pain journey.

 

 

A thorough chronic pain assessment could include laboratory blood testing, imaging such as x-rays and MRI scans and genetic testing. Some chronic pain conditions are expected to have normal test results, while others are notoriously difficult to test for. Some pain conditions, such as fibromyalgia, do not yet have a diagnostic test. Only some chronic pain illnesses will have positive blood test, x-ray or MRI, or genetic test results.

 TESTING

Laboratory or imaging testing can be used to further narrow down your diagnosis.

Specific testing is only available for SOME conditions.

A specific lab test for Fibromyalgia does not yet exist.

Testing for Lyme disease is notoriously difficult.

Some conditions are expected to have normal lab and imaging results.

Repeatedly receiving negative test results is a double-edged sword – on the one hand, you are relieved, while on the other hand, you wish that you would get some concrete answers as to the cause of your pain.

Some of the possible tests that you may need to undergo (2) are listed here:

  • Systemic Inflammatory Rheumatic Diseases
    • e.g. rheumatoid arthritis, lupus, ankylosing spondylitis, myositis
      • ESR, CRP, RF, anti-CCP, ANA, HLA-B27 and others
      • joint ultrasound
      • x-rays
      • MRI
  • Musculoskeletal Conditions
    • e.g. Ehlers-Danlos syndrome, myofascial pain syndrome, sacroiliac joint dysfunction, osteoarthritis, spinal stenosis, tendonitis, myopathy
      • genetic testing if available
      • MRI
      • CT
      • x-rays
      • joint blocks, nerve blocks
  • Endocrine and Metabolic Conditions
    • e.g. hypothyroidism, vitamin and nutrient deficiencies, sub-optimal thyroid function, anemia
      • TSH, PTH, T4, T3, TPO, antithyroglobulin antibodies & others
      • Vit D, Vit B12 & others
      • iron and ferritin levels
  • Gastroenterological Conditions
    • e.g. irritable bowel syndrome (IBS), celiac disease, food sensitivities
      • Transglutaminase antibody
      • colonoscopy
  • Infectious Diseases
    • e.g. hepatitis C, Lyme disease, cytomegalovirus, Epstein-Barr (mononucleosis)
      • Anti-HCV
      • Lyme disease testing
      • EBV antibodies & others
  • Malignancy (cancer)
    • testing depends on symptoms
  • Neurological Conditions
    • e.g. fibromyalgia, carpal tunnel syndrome, complex regional pain syndrome, multiple sclerosis, Parkinson’s disease, spinal stenosis, neuropathy
      • nerve conduction studies & others
      • evoked potential
      • MRI

 

Fibromyalgia, and many other chronic pain conditions, are often misdiagnosed. But, a correct diagnosis is VERY important for a chronic pain patient. Part 2 of the Ultimate Guide To Understanding Chronic Pain will help you to receive an accurate diagnosis quicker if you suffer from chronic pain conditions such as fibromyalgia, Ehlers Danlos, rheumatoid arthritis, osteoarthritis, myofascial pain syndrome, sacroiliac joint dysfunction, myositis, lupus and others.

 ARRIVING AT A DIAGNOSIS

Based on your medical & family history, physical examination, and test results, the doctors you visit should be able to narrow down your symptoms into one or more of these categories (2, 9) and hopefully confidently diagnose or rule out various medical conditions. Some diagnoses are made by virtue of exclusion – for example, a classic fibromyalgia diagnosis should be made only if all other causes of your pain have been ruled out (9).

  • Systemic Inflammatory Rheumatic Diseases
    • e.g. rheumatoid arthritis, lupus, ankylosing spondylitis, myositis
    • your immune system is not working properly and attacks your tissues
  • Musculoskeletal Conditions
    • e.g. Ehler-Danlos, myofascial pain syndrome, sacroiliac joint dysfunction, osteoarthritis, spinal stenosis, tendonitis, myopathy
    • the body’s proper form, support, stability, and movement is affected – involves the joints, ligaments, tendons, muscles, bones, fascia, cartilage, bursae, nerves and blood vessels
  • Endocrine and Metabolic Conditions
    • e.g. hypothyroidism, vitamin and nutrient deficiencies, sub-optimal thyroid function, anemia
    • endocrine glands produce and release hormones, which play a critical role in how your body functions; essential to maintaining life
    • metabolic conditions affect the body’s normal chemical reactions that break down molecules (e.g. to release energy from food) and that make new larger molecules from smaller ones (e.g. amino acids are used to make proteins); essential to maintaining life
  • Gastroenterological Conditions
    • e.g. irritable bowel syndrome (IBS), celiac disease, food sensitivities
    • dysfunction of the digestive system including the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver
  • Infectious Diseases
    • e.g. hepatitis C, Lyme disease, cytomegalovirus, Epstein-Barr (mononucleosis)
  • Malignancy (cancer)
  • Neurological Conditions
    • e.g. fibromyalgia, carpal tunnel syndrome, complex regional pain syndrome, multiple sclerosis, Parkinson’s disease, spinal stenosis, neuropathy
    • there is irritation, damage or dysfunction of your nervous system
  • Mental Health Disorders
    • e.g. anxiety, depression, somatoform pain disorder
    • impact your emotional, psychological and social well being but are also known to play an important role in chronic pain
  • Medication-Induced Pain Conditions
    • e.g. myopathy, hyperalgesia, peripheral neuropathy, arthralgia, bone pain, polymyositis
    • These medications have been associated with body pain:
      • Statins
      • Opioids
      • Chemotherapeutic agents
      • Aromatase Inhibitors
      • Bisphosphonates

An accurate diagnosis is dependent on how much experience & knowledge the physician you see has with the various pain conditions & the other medical conditions that closely mimic the symptoms of these pain conditions.

A large chunk of a proper diagnosis also has to do with how adept the physician is with a comprehensive physical examination as well as their ability to look at the big picture – to make connections between different symptoms and to be able to tease out multiple medical conditions in a single patient.

This list gives you an idea of what medical conditions the doctors you are seeing should be keeping in mind during their medical assessments (2, 3, 9):

  • Fibromyalgia
  • Osteoarthritis
  • Rheumatoid Arthritis
  • Psoriatic Arthritis
  • Systemic Lupus Erythematosus
  • Polymyalgia Rheumatica
  • Ankylosing Spondylitis (Inflammatory Spondyloarthritis)
  • Myofascial Pain Syndrome
  • Joint Hypermobility Syndrome
  • Ehlers-Danlos Syndrome (Hypermobility Type)
  • Hypothyroidism
  • Hyperparathyroidism
  • Chronic Fatigue Syndrome
  • Vitamin D Deficiency
  • Acromegaly
  • Hashimoto’s Disease (Chronic Lymphocytic Thyroiditis)
  • Celiac Disease
  • Anemia
  • Mitochondrial Energy Insufficiency
  • Lyme Disease
  • Hepatitis C Infection
  • Human Immunodeficiency Disease
  • Cancer
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Peripheral Neuropathy
  • Degenerative Disc Disease
  • Facet Joint Mediated Pain
  • Scoliosis
  • Myositis
  • Postural Distortions
  • Tendonitis
  • Migraines
  • Pompe Disease
  • McArdle Disease
  • Myoadenylate Deaminase
  • Myotonic Dystrophy Type 2
  • Neuromyotonia
  • Mechanical Low Back Pain
  • Sacroiliac Joint Dysfunction
  • Pelvic Girdle Dysfunction
  • Visceral (organ) Pain
  • Chronic Pelvic Pain
  • Endometriosis
  • Vulvodynia
  • Chronic Headaches/Migraines
  • Temporomandibular Joint Pain
  • Generalized Anxiety Disorder
  • Somatoform Pain Disorder
  • Depression
  • Medication-Induced Pain

 

Chronic pain patients usually seek out a large number of doctors and specialists in search of answers. Find out which specialists you should see to rule in or rule out various medical causes of your chronic pain and related symptoms. Some specialists you may see for your chronic pain are rheumatologist, neurologist, physiatrist, phsychiatrist, endocrinologist, pain management, sleep specialist, gastroenterologist, orthopedic surgeon, gynecologist & sports medicine.

SPECIALISTS

Chronic pain is a multi-faceted and complicated medical issue. There is a lot of interconnection between different body systems and it is best practice for us to have a multidisciplinary approach to our medical care.

You will likely have appointments with some, or many, of the following specialists on your chronic pain journey:

  • Rheumatologist
    • deals with the diagnosis and treatment of autoimmune and musculoskeletal conditions, including connective tissue disorders
  • Neurologist
    • deals with the diagnosis and treatment of nervous system disorders
  • Pain or Pain Management
    • deals with the diagnosis and treatment of pain conditions
    • usually this is a sub-specialty and the physician has other credentials such as physiatry, anesthesiology, psychiatry or neurology
    • Interventional Pain Specialist – has additional training and experience in minimally invasive treatments of pain such as facet joint injections, nerve blocks, joint blocks and injections, epidural injections & radiofrequency neurotomy
  • Orthopedic Surgeon
    •  deals with the diagnosis of musculoskeletal conditions & treatment through surgical and non-surgical interventions
  • Physiatrist or Physical Medicine & Rehabilitation
    • deals with the diagnosis and treatment of a wide variety of musculoskeletal and neuromuscular conditions
  • Psychiatrist
    • deals with the diagnosis and treatment of mental, emotional and behavioral disorders
  • Gastroenterologist 
    • deals with the diagnosis and treatment of digestive system disorders
  • Endocrinologist
    • deals with the diagnosis and treatment of the endocrine system & hormonal imbalances
  • Gynecologist
    • deals with the diagnosis and treatment of the female reproductive system
  • Sleep
    • deals with the diagnosis and treatment of sleep disorders
    • usually this is a sub-specialty and the physician has other credentials such as Psychiatry or Respirology
  • Sports Medicine
    • deals with the diagnosis and treatment of musculoskeletal conditions
    • usually this is a sub-specialty and the physician has other credentials such as physiatry or family medicine
Which doctor & what specialists should you see for your chronic pain? What testing do you need as part of an evaluation of your chronic pain? What are the relevant symptoms and family history details that you should include during your chronic pain assessment? Find out in The Ultimate Guide To Understanding Chronic Pain, Part 2: Chronic Pain Assessment.

(c) 2018, STRIVETOHEAL.COM

A WORD ON PAIN CLINICS

If your chronic pain is severe and is not responding to the various treatments you have tried so far, please discuss a pain clinic referral with your primary physician….that is if you haven’t yet had an appointment at one.

And if you have visited a pain clinic already but found that the treatment didn’t help, keep in mind that not all pain clinics are the same. They can differ in the types and quality of treatments they offer. You may need to visit more than 1 pain clinic in order to find the best fit for you as a person and as a patient.

The message here is that if 1 pain clinic didn’t meet your hopes and expectations, don’t throw in the towel! Always keep pushing forward looking for those missing pieces of your chronic pain puzzle.

I have so far been a patient at 2 pain clinics.

The first experience was an epic failure. I won’t go into details right now, but instead of making my severe pain better, by the time they threw in the towel on me because I wasn’t responding to their treatment plan, my pain was so much worse than when I first started visiting them (hint: they got my diagnosis wrong).

When I began attending my current pain clinic, my first reaction was that it strangely felt like I belonged there – like I had finally come “home”.

Nowhere else had I seen other people gathered in one place that were in obvious pain and that had the kinds of difficulties I was having with getting up from sitting, walking etc. The only missing link was that younger patients such as myself were outnumbered by older patients.

But, for the first time, I did not feel alone in this nightmare of a journey! I was no longer the odd one out! And all the staff genuinely understood my physical limitations – I never got strange looks or puzzled faces.

It is at this time that I really started realizing how lonely & isolating my chronic pain experience was.

It is one of those struggles where someone has to walk in your shoes for them to really understand what you are going through.

 

The fact that many chronic pain and chronic illness patients often see many doctors is NOT a sign that we are doctor shopping. Just the opposite, we are on a desperate search for answers and treatments so that we can start living again. Chronic pain warriors such as fibromyalgia, lyme disease, chronic pain syndrome, Ehler Danlos Syndrome (EDS) and many other patients can attest to this.

WE ARE NOT “DOCTOR SHOPPING”

Unfortunately, a journey such as ours, to find a physician who really understands and is knowledgeable about our medical issues, can simplistically be looked upon by an unsupportive employer or an insurance company that keeps denying your long-term disability claim, as “doctor shopping”….even though this couldn’t be any further from the truth.

We are actually in a FIGHT FOR OUR LIFE. Our pain may not literally kill us, but it does make us live a limited existence as we survive from one day to the next.

We have to be stronger than others can imagine in order to keep pushing forward in our quest to heal & regain a sense of actually LIVING our life.

So my fellow warrior, if you haven’t already been through numerous doctor appointments, don’t be surprised if it takes time to find physicians that you feel comfortable with and confident in.

In my situation, I voiced concerns to a few physicians and allied health professionals over a span of 3 years but it wasn’t until I saw my current primary physician that my complaints were taken more seriously & I finally received a proper & thorough clinical evaluation, along with testing and specialist referrals.

And even then, it took several specialist referrals in order to find a specialist that actually took the time to really listen to my long history, to perform a thorough investigation including nerve and joint blocks & to be insightful enough to identify more than 1 type of pain and more than 1 chronic pain condition.

And although at the time I didn’t totally grasp or understand his list of diagnoses, I knew it in my gut that the prior specialists I saw were missing the mark in their assessments. I have more than a few “interesting” stories that I can share but I will leave that for another time.

Knowing what I know now about my medical issues, I can’t comprehend how I fell through the cracks over and over again.

We should NOT have to fight so long to get a proper diagnosis and proper treatment.

Because with chronic pain, time is health – the longer we have chronic pain that is not treated properly, research keeps saying, the bleaker our outcome.

But I am determined to not let chronic pain have its last say. I am determined to keep striving to heal, to attack my chronic pain from all directions. Because I keep learning that there is actually a lot more that WE can do as patients – to help ourselves on our healing journeys.

So join the fight with me, and let’s heal together!

 

Chronic pain assessment guidelines and their awareness are getting better, but too many chronic pain patients still fall through the cracks or get misdiagnosed. Find out all you need to know about what type of chronic pain evaluation you SHOULD have so that you get diagnosed QUICKER and CORRECTLY. This guide covers specialist referrals, testing, physical examination, symptoms and family history symptom list, possible diagnosis list, information on pain clinics and a lot of personal insight.

(C) 2018, STRIVETOHEAL.COM

 

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  1. Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York: Viking, 2007.
  2. HAUSER W, PERROT S, SOMMER C, SHIR Y, FITSZCHARLES MA: Diagnostic confounders of chronic widespread pain: not always fibromyalgia. Pain Rep 2017; 2(3); e598.
  3. ELLER-SMITH OC, NICOL, AL, CHRISTIANSON JA: Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Front Cell Neurosci 2018; 12; 35.
  4. YASAEI R, SAADABADI A (2018): Pain, Syndrome, Chronic. Treasure Island, FL: StatPearls Publishing [Internet].
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  6. MALFAIT F, FRANCOMANO C, BYERS P, BELMONT J, BERGLUND B, BLACK J, BLOOM L, BOWEN JM, BRADY AG, BURROWS NP, CASTORI M, COHEN H, COLOMBI M, DEMIRADAS S, DE BACKER J, DE PAEPE A, FOURNEL-GIGLEUX S, FRANK M, GHALI N, GIUNTA C, GRAHAME R, HAKIM A, JEUNEMAITRE X, JOHNSON D, JUUL-KRISRENSEN B, KAPFERER-SEEBACHER I, KAZKAZ H, KOSHO T, LAVALLEE ME, LEVY H, MENDOZA-LONDONO R, PEPIN M, POPE MF, REINSTEIN E, ROBERT LE, ROHRBACH M, SANDERS L, SOBEY GJ, VAN DAMME T, VANDERSTEEN A, VAN MOURIK C, VOERMANS N, WHEELDON N, ZSCHOCKE J, TINKLE B: The 2017 international classification of the Ehlers-Danlos SyndromesAm J Med Genet C Semin Med Genet 2017; 175 (1); 8-26.
  7. TINKLE B, CASTORI M, BERGLUND B, COHEN H, GRAHAME R, KAZKAZ H, LEVY H: Hypermobile Ehlers-Danlos Syndrome (aka Ehlers-Danlos Syndrome Type III and Ehlers-Danlos Syndrome Hypermobility Type): clinical description and natural historyAm J Med Genet C Semin Med Genet 2017; 175 (1); 48-69.
  8. COX JT, GULLOTTI DM, MECOLI CA, LAHOUTI AH, ALBAYDA J, PAIK J, JOHNSON C, DANOFF SK, MAMMEN AL, CHRISTOPHER-STINE L: “Hiker’s feet”: a novel cutaneous finding in the inflammatory myopathies. Clin Rheumatol 2017; 36 (7); 1683-1686.
  9. Brady, David. The Fibro Fix. New York, NY; Rodale, 2016.

caption id=”attachment_633″ align=”aligncenter” width=”600″]Do you have a new FIBRO diagnosis and have to idea where to start learning about your illness? The Ultimate Guide To Understanding Chronic Pain provides the latest information on what research and clinicians are telling us about chronic pain. Part 2 covers chronic pain assessment & evaluation. (c) 2018, STRIVETOHEAL.COM[/caption]

Do you know that many chronic pain patients, including fibromyalgia or fibro patients are actually misdiagnosed? Find out all you need to know about what a comprehensive chronic pain evaluation should be like so that you get diagnosed CORRECTLY!

Do you know that many chronic pain patients actually suffer from MORE THAN 1 chronic pain condition? Check out this post to see if you have been misdiagnosed, or if you do not have a completely accurate diagnosis.

(c) 2018, STRIVETOHEAL.COM

Even if you already have a fibromyalgia diagnosis, you NEED to check out this post because many fibro patients are MISDIAGNOSED & many chronic pain patients are actually suffering from more than 1 pain type & from more than 1 pain condition. Check out this guide to see if you could be one of them.

(c) 2018, STRIVETOHEAL.COM

Not sure what to expect during your chronic pain assessment? This guide covers which doctor you should see first, different pain types and pain mechanisms, symptoms, family history, specialist referrals, physical examination, laboratory testing, imaging testing, diagnosis & pain clinics.

(c) 2018, STRIVETOHEAL.COM

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