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Industry: Email Alert RSS FeedApproach to assessment and diagnosis of chronic pain
Journal of Family Practice, Oct, 2004 by Stephen Brunton
In many NP syndromes, the results of clinically available laboratory tests are normal. For example, nerve conduction velocity (NCV) and electromyography (EMG) measure only the status of large nerve fibers, and cannot assess small-fiber function. Since many painful neuropathies affect only the small nerve fibers, the NCV and EMG tests will be normal. Diagnostic testing that could assist in diagnosis (eg, quantitative sensory testing) often requires specialized equipment and interpretive expertise not generally available in the primary care setting. Diagnostic imaging often is not useful initially in identifying the anatomic cause of the chronic pain since the abnormalities causing the pain may not be detected, while other abnormalities may be. Instead, imaging should be used generally to confirm or rule out the suspected cause of the chronic pain. For example, in patients 50 years of age and older with low back pain, simple radiography is useful to rule out underlying systemic diseases, (37) while magnetic resonance imaging is useful to identify patients suspected of having early-stage rheumatoid arthritis. (38)
* SUMMARY
A thorough assessment is essential to the effective short- and long-term management of chronic pain. Patient self-report is the most important source of information in pain assessment. Numerous assessment tools to characterize the pain as well as possible contributing factors, are available and can be used to complement the history and physical examination. Laboratory and diagnostic testing are primarily used to confirm or exclude underlying causes.
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