Chronic pain affects a lot of people every year and many receive a diagnosis in order to determine the appropriate treatment for this condition.
But first of all, what is a diagnosis? If you look at the Merriam-Webster dictionary it would be this:
“the art or act of identifying a disease from its signs and symptoms”
“investigation or analysis of the cause or nature of a condition, situation, or problem”
In the world of pain, you are trying to determine the cause/nature/disease based upon signs and symptoms. On rare occasion, a pain diagnosis can be life-threatening. These often present with what are commonly called “red flag” symptoms. These may include the inability to control your bowel or bladder or severe abdominal pain.
But let’s assume that those red flags are ruled out with no rare life-threatening condition. Yet you still have persistent or intermittent pain. Why would a chronic pain diagnosis possibly be unhelpful?
Chronic Pain: When A Diagnosis Is Unhelpful
Here are some things to consider when weighing up your diagnosis options:
Your diagnosis may be wrong
Each person’s pain experience is unique and each pain professional has a different perspective and set of skills to assess what led to or is causing your pain. Sometimes it is very straightforward like a splinter in a toe. Other times it is complex like lower back pain, which can have many possibilities. When a symptom such as back pain is evaluated, a list of possibilities or a “working diagnosis” may be used temporarily to see if the pain resolves based upon the most likely cause and associated treatment. It’s kind of like treating an infection with antibiotics without knowing the exact bug or bacteria from a culture. If it works, great (but you may need to replenish your gut microbes or flora!). If not, more investigation or another drug is tried next.
Pain is complex. If you are given a diagnosis of knee pain and there is a focus on the imaging finding of an injured meniscus, then you will likely be offered surgery. If you have surgery and you still have the same pain or more, then you must ask the question if you were barking up the right tree. The thoughtful surgeons will encourage patients to get specialized physical therapy. Go for personalized sessions.
Part of the pain journey is deciphering which explanation makes the most sense for your pain. You need a dialogue with a pain professional to determine if you are on the right track.
Your diagnosis may only describe your symptom(s)
Many diagnoses such as lower back pain, sciatica, headache, complex regional pain syndrome (CRPS), or fibromyalgia are describing a single symptom or a set of multiple symptoms. The question is again, “Why?” or “Why do I have these symptoms?”. It is not uncommon for pain professionals in the traditional medical system to only treat the symptoms of a diagnosis. However, taking pain medication long-term without understanding why the pain is there in the first place is not a wise course of action.
A headache could be due to dehydration, stress, lack of sleep, or a medication. Other causes could be withdrawal from caffeine, muscular tension or more serious issues. If you are only told you have a headache, then it makes it difficult to find the appropriate treatment. Again, describing your symptom does not always mean you know the strategy or solution to your pain.
Fibromyalgia or CRPS are unique susceptibilities or sensitivities of the nervous system, but their detailed definitions do not necessarily tell you why the symptoms exist. Just because there is a specific name for those set of symptoms, that does not mean that there is a specific cure. Yet, those conditions can be improved with a combination of patient and/or pain professional efforts.
Although some conditions are difficult to understand, there should be an attempt to unveil the root cause of the symptoms. More importantly, if the potentially reversible acute pain is not addressed early, the risk of chronic pain increases.
Your diagnosis may only refer to failed treatments
When diagnosed with post-laminectomy syndrome or failed back syndrome, this only tells you part of the story. It might tell you that the surgery you were given did not help the pain that was being addressed in the first place. Perhaps it shows that there were complications or new pain from that surgery. In the former, the pain is not explained nor does it give you any direction for a possible resolution.
You may need a re-evaluation from a different pain professional to decipher the more likely root cause of the issue. Then a different strategy can be considered.
Your diagnosis based on imaging does not tell the whole story
Many imaging findings reflect wear-and-tear. To the non-medical person, the fancy terminology that describes those abnormalities can lead to concern and belief that the findings are the source of the pain. This can be disempowering as if nothing can be done to change the circumstance.
Most abnormal imaging findings (especially in the lower back) are found in many people who have NO pain also. Many patients pursue more aggressive options merely from the perceived importance of abnormalities, especially if endorsed by that pain professional. Asking the pain professional whether it is an emergency is a good place to start. If it is not an emergency, then asking what the other options are is another good question.
Easing Chronic Pain
In summary, as satisfying as it can be to put a name to a condition, avoid the diagnosis hypnosis. You may want to dig deeper and ask the question that many patients hesitate to ask, “Why?” or “Why do I have this pain?”.
Even if the root cause of the chronic pain has not been found, you can still apply some helpful techniques. You can do certain things with your mind and body that legitimately helps decrease the experience of pain (e.g. good sleep, proper nutrition, quit smoking, quit drinking, drink water, light exercise, decrease stress, cognitive behavioral therapy, etc). Also, the body is naturally self-healing. Sometimes pain may self-resolve especially if the symptoms continue to get better and better. And if you are not getting better, then find a pain professional that will listen to your story. Be equally invested in discovering the root cause of your pain even if that means asking for help from other pain professionals.That way, you can ease chronic pain and be back to your best.
For greater insight into interacting with patients suffering from chronic pain or if you would like to chat with others affected by it, I highly recommend joining the app, Reachout.
Melissa Cady is a physician trained in an osteopathic medical school followed by allopathic postgraduate training in general surgery, internal medicine, anesthesiology, and pain medicine. Dr. Cady is currently board-certified in anesthesiology and fellowship-trained with a board certification in pain medicine. Dr. Cady can relate to her own subject matter, as she has endured and managed her own chronic pain. Her strong desire to overcome it has made her a passionate patient advocate for optimizing health through rational means while minimizing excessive and unnecessary medical interventions. Dr. Cady is the author of PAINDEMIC: A Practical and Holistic Look at the Chronic Pain, the Medical System, and the antiPAIN Lifestyle, and is also the founder of www.PainOutLoud.com.