Diagnosing Chronic Pain Syndrome [CPS]

Diagnosing chronic pain syndrome can be quite complex, as there are often many interrelated factors - both physical and mental.

Diagnosis is often based on the following:

• The patient has chronic complaints of pain
• Symptoms are greater than expected for the causation on physical exam
• There has been minimal, if any relief with standard treatment
• There is a sometimes a history of having seen many physicians
• Use of several non-specific medications

Detailed Questionnaire

Obtaining the history of patients whose symptoms suggest CPS to direct further evaluation and appropriate consultations and avoid invasive and expensive procedures. A detailed questionnaire should include:

1. A characterization of the pain - helps establish appropriate diagnostic and therapeutic plans.
2. Pain location - using a pain diagram (anterior/posterior and lateral view of human picture).
3. Factors that provoke or intensify the pain - may provide clues for possible etiologies or associated disorders.
4. Factors that alleviate the pain – e.g. rest may decrease pain of musculoskeletal origin.
5. Quality of pain – such as throbbing, pounding, shooting, pricking, boring, stabbing, sharp, cramping, crushing, pulling, pinching, stinging, burning, splitting, penetrating, piercing, squeezing, and dull aching.
6. Radiation of pain – if it spreads or radiates. Spreading or radiating pain is a characteristic of neuropathic pain.
7. Intensity of pain – using an adopted pain scale
8. Medical hstory specific to different systems and disorders – Musculoskeletal, Neurologic, Gynecologic and obstetric, Urologic, Gastrointestinal, and Psychological – especially when organic diseases are excluded or coexisting psychiatric disorders are suggested.
9. Evaluate for mental unwellnesss - depression; anxiety disorder; somatization; physical or sexual abuse; drug abuse/dependence; and family, marital, or sexual problems.

Systemic Examination

A detailed review of the musculoskeletal, reproductive, gastrointestinal, urologic, and neuropsychological systems must be obtained.

An open minded approach and good rapport is important when evaluating any patient with chronic pain.

Laboratory Studies

Laboratory studies include routine CBC count, urinalysis, and selected tests for suspected disease are important. Urine or blood toxicology is important for drug detoxification, as well as opioid therapy.

Imaging Studies

Several imaging studies may be done, including x-rays, MRI, and CT scan.

NEXT: Treating Chronic Pain Syndrome

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CHRONIC PAIN SYNDROME | Causes | Symptoms | Diagnosis | Treatment | After Care