Yes!
Most patients, when they get some pain would go to family physician, physiotherapist, general physician, orthopedic surgeon, a neurologist etc. It is only when their pain does not respond to treatment by these doctors that they get referred to a pain specialist or they will try to find one through personal contacts or on the internet. (More than 70-80% of patients who come to our clinic are referred by our previous patients). The most important feature of treatment by any pain specialist is that we focus on the main cause of pain and its treatments and then once the patient is comfortable, we turn our attention to the disease causing the pain and its treatment.
When the patient reaches our clinic, our protocol is as follows:
- Detailed history that includes the following:
- History specific to the pain which includes the intensity, quality, duration, constancy of pain along with a pain diagram which is a pictorial representation of the location of pain. The distress caused by pain is also documented.
- We also document the effect of pain on the activities of daily life, like limitations in the duration of standing, walking and sitting, or any other activity. This documentation helps for comparison with post treatment improvement.
- Previous pain history and any previous pain interventions
- Any other pains elsewhere in the body.
- General medical history to understand any possible contribution from the associated conditions (comorbidities) and drug interaction
- A brief psychological profile of the patient, whether there is a tendency to get stressed out in general or whether there are any tensions in personal or professional life.
- Examination – History is followed by a thorough examination to delineate the painful areas, tender areas, hypersensitive areas and whether they correspond with patient’s description. We particularly document limitations of movements and pain on movement with still and video pictures. The privacy of the patient is ensured by avoiding photography of the face unless of course it is a facial pain in which case we will ensure that the patient has no objections by taking a prior consent.
- Investigations – The available investigations are scrutinized and if necessary new investigations which are relevant to the present pain will be prescribed. We routinely ask for blood tests to look for any deficiencies particularly of vitamin B12 and D3 which are almost invariably low in Indian pain patients. We also might ask for C reactive protein which will indicate if there are some inflammatory processes that might explain the cause of pain.
The information from the above is usually sufficient to arrive at a probable working diagnosis. Additional investigations like X-Ray, CT, MRI etc will be asked for if we require further confirmation. History and examination itself takes about an hour in most patients. We then discuss the probable diagnosis and probable treatments with the patient and the family. In patients with severe pains the treatment may be started on the same day but usually patients are given a later appointment for treatment.