ABCs of Chronic Pain Evaluation

Abstract

Chronic pain affects people all over the world. Effective treatment of chronic pain depends on a patient-centered approach to aim for a functional restoration and emotional rehabilitation of patient at an early stage. This chapter stresses the importance of complete patient evaluation including social and psychological evaluation. Any evaluation should not only include a detailed account of the patient's pain, functional limitations, prior medications, prior procedures/interventions, substance abuse, and psychiatric disorders, but also social issues, and pain coping skills. Physical examination may not add much but goes a long way to develop trust with the patient. Blood tests in general are best left for the other specialists to order and interpret. Imaging tests have great value in ruling out stuff and reassuring patients to be active, while electrophysiological testing has a value in localizing nerve pathology and a prognostics value but not much value in the overall management of pain. Overall the evaluation should focus on finding a disease process that can be treated and if not present, effort should be made to minimize testing as it feed into a narrative that patient is not getting better.