How Do You Diagnose Pain Like a Pain Specialist (Step by Step)

Living with chronic pain can be debilitating and isolating, leading to feelings of helplessness and confusion. In this article, we look at the processes of diagnosing chronic pain like a pain specialist to help break down some of that confusion.

Rather than starting with how we can diagnose pain like a specialist, let's take a step back and ask how we should even approach assessing chronic pain. For me, this is a higher-level question before we formulate a diagnosis.

For context, this article will focus on chronic pain rather than acute pain and the steps I take as a general practitioner. Secondly, as I share the approach I usually take when I see a patient with chronic pain, you might notice that some parts of that approach can be helpful for people trying to understand their pain to apply for themself. I will note these when appropriate.

Before we begin to diagnose pain

There are a few important factors to consider even before approaching an assessment.

And unlike an obvious flesh wound, an abnormal reading on a lab result, or an injury shown on a scan, chronic pain is invisible and often impacts the patient's life much more than other conditions.

When someone has never experienced chronic pain, it can be very hard to relate to how demoralizing, disorienting, and limiting life with daily pain can be. This is why having a doctor that is patient, empathetic, compassionate, and understanding can help you feel seen and truly supported.

By the time a patient with chronic pain sees me, often, they have already seen other healthcare providers. Sadly, some have had experiences that make them feel like getting help is an uphill battle - experiences like not being believed, feeling stigmatized as someone shopping for prescription drugs, or being dismissed due to a normal-looking scan result.

In my practice, I often see how a little bit of extra empathy and compassion goes a long way and helps form a therapeutic connection with my patient. It is worth noting that, one of the goals I aim to achieve with all of my patients who live with chronic pain is for them to foster self-compassion and understanding, which can be very powerful for them.

It’s also important that my patient knows we’re working on their pain together. I often describe it as a "group project".

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How do you get a pain diagnosis? (Clinical assessment)

My approach is to break it down into segments. This is how I also teach fellow doctors in training.

Step 1: Assess the pain itself

This is then broken down into two areas:

  • The history of the pain (this could go back months and often years)
  • How did the pain start?
  • Did it start slowly or quickly?
  • Did it start after an injury or come on insidiously?

Step 2: Assess the pain as it feels now

This is usually a closer assessment, zooming into the recent days and weeks.

  • Where is it?
  • Does it move around?
  • What makes it better?
  • When does it come on?
  • What does it feel like?
  • Do you think you’re experiencing different types of pain?
  • How bad is it? What is the range of severity?
  • Are there associated symptoms along with the pain?

Step 3: Assess the other factors that influence the pain

  • Have you noticed anything influencing the pain? Things like stress, mood, weather, activity, or anything else
  • What makes it better?
  • What makes it worse?
  • What treatments have you tried in the past? What was that like and what did they do to your pain?

Step 4: Assess the degree to which the pain impacts the patient’s comfort & function

  • What’s your life like with the pain?
  • What’s a typical day like with the pain?
  • What can you do when your pain is worse vs when your pain is better?

This detailed assessment allows us to set realistic goals and create reasonable treatment plans.

How do I know if my pain is serious?

How do we define serious? If it is impacting your wellness, life, and function, then I would say it is serious! In a medical sense, serious is defined as having a "serious underlying cause". Usually, patients know when their pain is different or abnormal, and if you're not sure please talk it over with your doctor. When you live with chronic pain, sadly, it doesn't stop you from experiencing other types of pain.

You can still stub your toe, cut your finger, or develop other conditions that cause different types of pain than your usual symptoms.

If you're familiar with MoreGoodDays and have read our other articles, you might have read that the weird thing about pain is that it is there to protect you.

This is one theme I routinely speak to my patients about to help get their heads around what they’re experiencing. Your pain is not an enemy, it’s a friendly mechanism that’s supposed to protect you. But for some people, it's not functioning correctly and is misreading the situation and sending the wrong signals.

Your pain could be a diagnosis itself, or it could be a symptom of an underlying diagnosis, but from a patient’s point of view, pain is pain. I always encourage my patients to try to assess the pain for themselves (by keeping a pain diary). This is helpful for information gathering and can often be an empowering and therapeutic exercise.

Often I see patients who experience chronic pain who are looking for this one single underlying diagnosis that answers all our questions and explains all the suffering.

Yet, that's rarely the case.

From a patient's point-of-view, if you experience chronic pain, you have chronic pain. From a medical point of view, it can be tricky to work out the whole picture, categorise the types of pain you suffer chronically, and work out how we diagnose your condition. It's also worth noting that often conditions that cause pain can overlap. For example, you can have fibromyalgia and arthritis.

There's no sure-fire way to test for your pain, but we would often request scans (like X-rays, CTs or MRIs) to investigate - this is usually to look for an underlying structural cause of your pain.

Most patients who suffer from chronic pain may not have a visible underlying cause.

In my experience, over-investigating can sometimes take the focus away from treating the pain head-on and veer our attention off course towards being stuck with looking for a visible problem.

There have been frequent cases where if we see abnormalities on a scan, whatever we see may not even be the main cause of the pain. A good example of this is people with back pain having a scan that shows some degenerative changes in the spine.

Pain is invisible.

There is no way to test specifically for your pain (outside of some research settings where functional MRI is used and can show your brain "experiencing" pain.

In short, scans are there to help rule out a serious diagnosis. Scans rarely tell us the whole picture. The most helpful information we can gather to formulate a diagnosis is still from you, and the details about your symptoms.