Questions Help Determine Cause of Chronic Pain

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Determining whether chronic pain is caused by tissue damage, a neural pathway, or a combination of both is essential in providing proper treatment to patients, according to an article by Howard Schubiner, MD.

Dr. Schubiner developed four questions that can help physicians determine the origin of the pain, as origin is imperative to choosing the correct treatment.  

The first question Dr. Schubiner asks is if there is a clearly defined medical disorder that explains the patient’s symptom(s). Doctors must eliminate the possibility of any structural cause for symptoms before they can attribute chronic pain to a PDD.

The second question is if the patient has a history of other PDDs. Dr. Schubiner recommends making a list of potential PPD symptoms that have occurred in the patient’s lifetime and note at what points they began or occurred. The more previous symptoms they have had, the higher the likelihood that the current symptoms are also due to a PDD.

Next, he asks if the patient has a history of significant stressful events, particularly early in their life. Injuries or stressful life events create sensitized pathways in the brain, and these pathways can be triggered by stressful events later in life. The pathways can be created by physical or emotional trauma, and both can manifest as physical pain when triggered, even years after the initial trauma. However, patients without major trauma can still have PPD.

The last question is if any significant life events were occurring at the onset of the patient’s symptom(s). Dr. Schubiner finds that discussing a patient’s life trajectory can often reveal events in their early life that coincide with a current stressful life event. In these cases, the current, triggering event has similar emotional content as the early-life event.

Even after asking these four questions, the underlying cause of chronic pain may not be clear. In these cases, Dr. Schubiner recommends careful physical examinations and reviews of all available lab and imaging studies. In some cases, chronic pain can result from both structural issues and a PPD.

Misdiagnosing a PPD as a structural issue can exacerbate the problem by creating more fear and thus more pain in the patient. Providing patients with the correct diagnosis is imperative in order for them to take the correct steps toward recovery.

Female patient
Questions Help Determine Cause of Chronic Pain
Millions of people suffer with chronic pain and other disorders for which physicians haven't been able to define a clear medical problem or effective treatment. Few patients or doctors are aware that neural pathways can be the cause for their chronic symptoms, as opposed to tissue damage conditions. This distinction is critical and these questions will help sort this out.
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