Pain Diagnosis and Treatment Options

The real measure that this pain intensity rating captures is the efficacy of the pain medication or modality being used to treat the pain. However, the simple numeric rating does not capture the true essence of the total pain experience. Most patients who rate their pain at a level of 3 out of 10 or lower can participate in daily activities. A decrease of 3 points on the numeric intensity scale is considered to be clinically significant, and in many cases it is the best outcome possible.

Many exams and tests are used to evaluate chronic pain. An initial assessment includes:
A detailed medical history.
Your doctor will ask you about your general medical history, past illnesses, and overall health. He or she will ask you questions about your pain, previous pain episodes, how they were treated, and whether treatment was successful. Also, your doctor will note any family history of chronic pain. In order to identify activities that cause pain, how you treat pain when it occurs, and whether the treatment relieves the pain, your doctor may ask you to start keeping a pain diary.
A physical exam.
Your physical well-being will be evaluated, which will help your doctor identify areas of pain. You may be asked to move your limbs to help identify painful areas. A physical exam may uncover health conditions that contribute to chronic pain. As part of your physical exam, you may also have a neurologic exam to identify possible nervous system problems, and a mental health assessment to evaluate your emotional functioning and ability to think, reason, and remember.
Diagnostic tests.
These tests are often used to rule out other health conditions that can cause chronic pain. Tests may include blood tests, X-rays or other imaging tests (such as CT scans, MRIs, or ultrasounds), Electromyogram (EMG) and nerve conduction studies or other nerve tests, Angiogram or other vascular studies and Diagnostic nerve blocks.

Common pain problems can often be managed by your primary care provider. When pain is more difficult to treat, help from additional healthcare professionals and others with specialized training in pain may be required. Pain is complex and unique to each individual. For this reason, your healthcare team will consider many aspects of your pain and daily life before recommending a treatment program, including the type of pain (whether it is acute or chronic), the category of pain (nociceptive or neuropathic), its intensity, your physical condition and your lifestyle and preferences for treatment.

In some cases, pain is best managed using a combination of treatments. This is referred to as a "multi-modality" approach. For example, your healthcare provider may prescribe a medication along with activities to reduce stress (e.g., yoga, deep-breathing exercises). To improve daily functioning, specific therapies may be suggested to increase muscle strength and flexibility, enhance sleep and reduce fatigue, and assist you in performing usual activities and work-related tasks. While there are a variety of treatment options available for those living with pain, different therapies might not work for everyone. Finding the right combination may take time, but often makes the critical difference in your care. As always, it is important to weigh the risks and benefits of different pain treatments and consult your healthcare provider before starting or changing any treatment.

Medications play an important role in the treatment of pain. Many different medicines can be used to help relieve pain. A few, such as aspirin, ibuprofen and acetaminophen, can be purchased in a pharmacy or supermarket without a prescription, but most pain relievers are only available with a prescription from your healthcare provider. Some medications used to treat pain are not usually thought of as pain medicines, but they have been shown to relieve specific types of pain. For example:
• Some drugs used to manage depression or seizures can be used to treat neuropathic or nerve pain.
• Some steroid medications, such as prednisone and dexamethasone, may be used to treat pain caused by inflammation or bone disease.
• Some medications used to relax muscles or treat insomnia or anxiety may be used in the overall management of pain.

There are three major classes of medications for pain control: Non-opioids: non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen Opioids (may also be called narcotics): codeine and morphine are examples Adjuvant analgesics: a loose term referring to the many medications originally used to treat conditions other than pain, but now also used to help relieve specific pain problems; examples include some antidepressants and anticonvulsants. Some of these drugs have been shown to work well for specific types of pain. Drugs that have no direct pain-relieving properties may also be prescribed as part of a pain management plan. These include medications to treat insomnia, anxiety, depression and muscle spasms. They can help a great deal in the overall management of pain in some persons.

Research shows that pain can affect your emotions and behavior and interfere with your ability to concentrate, manage everyday tasks and cope with stress. Likewise, stress and emotional pressures can make pain worse, provoking "flare ups" and contributing to alterations in the immune system response. These relationships are not always easily recognized or readily fixed by medical procedures or medications alone. As the science of pain moves forward, there is growing evidence that interventions (drug and non-drug) used to influence emotions, thinking and behavior can aid in the reduction of pain and associated distress. For example, studies are uncovering a biological link between the brain systems involved in depression and pain regulation. Some antidepressant medications may have analgesic properties, which may be because these systems have shared properties. Some people experience depression due to chronic pain. Others may begin to realize that depression was present before their pain began. Depression can make the experience of living with persistent pain more difficult and should be diagnosed and treated.

Physical methods have been used for pain relief for centuries. Today there are a variety of skilled healthcare professionals with specialized training in the use of physical techniques that help reduce pain. Many work in the field of rehabilitative medicine, and include physiatrists (physicians who specialize in physical medicine), physical therapists, occupational therapists and exercise physiologists.

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