After completing your health history, your health-care provider will give you a thorough physical examination and review any diagnostic tests you've had in the past.
A general physical examination is appropriate for anyone with chronic pain, but the history may lead to an examination that focuses on one area. For example, if your health-care provider suspects that your pain is caused by nerve damage (neuropathy), a careful neurologic examination (including tests to evaluate muscle strength, reflexes and sensation) may be best, whereas careful joint examination is more important if your pain is thought to be caused by arthritis.
If you haven't had any diagnostic tests before, your health-care provider may order specific tests such as X-rays, magnetic resonance imaging (MRI), computed tomography (CT), nerve function tests or blood tests. The tests that your doctor orders will depend on your type of pain:
- X-rays are particularly good for seeing problems with bone that can cause pain, such as fractures or arthritis. They are also useful for diagnosing certain types of cancer.
- MRI is better for looking at soft tissues and organs. An MRI can reveal some types of nerve problems, such as pinching or compression. It can also spot any unusual growths, such as a malignancy. Some people, however, cannot have MRI because they are claustrophobic or have metal in their bodies (such as a pacemaker). These people may need to have an "open MRI" or CT instead.
- CT provides better bone detail than MRI does, but it is similar to MRI when used to determine the cause of pain.
- Nerve function tests measure how electrical signals travel along nerve pathways. They are used to help diagnose nerve damage.
- Blood tests may show evidence of inflammation, infection or another illness that may be causing your chronic pain.
These tests can also rule out some diagnoses. For instance, if your health-care provider suspects that a tumor may be the cause of your chronic headaches, he or she may order an MRI. If the test shows no tumor, your health-care provider needs to explore other possible causes for your pain.
Sometimes, a health-care provider will repeat a test, particularly if your pain has changed in some way. In other cases, a health-care provider won't order any tests because earlier exams already answered the key questions, and further testing is unlikely to turn up anything new.