How is pain diagnosed?

Medical history and physical examination: Diagnosing the underlying cause of pain can be difficult. When an individual experiences pain, a doctor may take a number of steps to assess the pain and attempt to determine its cause. Assessment of pain typically begins with a discussion of the individual's medical history and a physical examination. A medical history, which includes age, weight, current and past medical problems, medications, and height, is taken. In the discussion portion of the pain assessment, the individual may be asked to describe the pain according to: when it started; what it feels like; how bad it hurts; where it's located; and factors that improve or worsen the pain.

The doctor may use a pain diagram or picture of the human body to evaluate the pain. The individual will mark the area or areas where pain is felt on the chart. Doctors may also use pain scales, which help quantify the pain intensity. Individuals with pain who visit their doctor are often asked to rate their pain on a 0 to 10 scale, with 0 being "no pain" and 10 being "the worst pain imaginable." This is a valid and simple way to monitor an individual's pain. However, pain perception is very subjective and varies from one individual to the next.

During a physical examination, a doctor will inspect the area of pain, looking for visual signs of causes, such as trauma and injury. Depending on the location, the doctor may test joints and muscles for strength and range of motion.

Blood and urine tests: Blood and urine tests can help diagnose diseases that may be causing pain. They can identify abnormal amounts of hormones, enzymes, or other body chemicals that may indicate disease.

Computed tomography (CT) scan: Computerized tomography (CT) scan is an x-ray that uses computer technology and can be enhanced with the injection of a contrast dye into a vein. CT scans allow for multiple X-rays to be taken from different angles around the body where the pain is located to create a three-dimensional image of internal body structures. CT is used to show abnormalities in bones and soft tissue. CT scan can be used for individuals who are unable to tolerate MRI.

Electromyography (EMG): Electromyelography (EMG) is a test that identifies muscles and nerves affected by weakness or pain. EMG works by measuring the electrical activity generated by active muscles. A lumbar puncture (spinal tap) will be performed in order to inject contrast dye into the cerebrospinal fluid in the spine. This allows the doctor to outline the spinal cord and nerve roots, and abnormal disc conditions or bone spurs can be visualized using an x-ray or CT scan. EMG is often used along with nerve conduction studies.

Magnetic resonance imaging (MRI): Magnetic resonance imaging (MRI) tests use a powerful magnet to produce images on a computer screen and film. Magnetic resonance imaging (MRI) scans provide clear images of disc deterioration, pathologies of the spinal cord, spinal stenosis, herniated discs, spinal tumors, and abnormalities in nerves and ligaments. An MRI is conducted in a small, confined area, and some individuals may find this uncomfortable. Some individuals may have to be sedated using a mild sedative such as alprazolam (Xanax) or lorazepam (Ativan). If the individual is sedated, transportation should be organized using a family member or friend.

Nerve conduction studies (NCS): Nerve conduction studies (NCS) evaluate muscle or nerve damage. These tests function by measuring the speed of electrical impulses through the nerves.

Radioactive bone scan: Radioactive bone scans locate problems (such as a fracture or osteoporosis) in the vertebrae. A chemical called a radioactive tracer is injected into the patient and after several hours, a picture using a gamma camera (a medical imaging device) will reveal bone undergoing rapid changes where large amounts of tracer accumulate.

Spinal tap: Spinal taps involve drawing a sample of cerebrospinal fluid and analyzing it for elevated pressure, infection, bleeding, or tumor. Spinal taps may be painful and may require sedation.

X-ray: X-rays are low doses of radiation that create an image of a body part, organ, or bodily system on film paper or fluorescent screens. X-rays show the alignment of the spine and may reveal degenerative joint disease, fracture, or tumor.