Chronic Pain Syndrome Workup

  • Author: Manish K Singh, MD; more...
 
Updated: Feb 24, 2012
 

Approach Considerations

The decision to perform any laboratory or imaging evaluations is based on the need to confirm the diagnosis and to rule out other potentially life-threatening illnesses. Sometimes certain investigations are needed to provide appropriate and safe medical or surgical treatment. The recommended treatment should be based on clinical findings or changes in examination findings.

Extreme care should be taken during diagnostic testing for chronic pain syndrome (CPS). Carefully review prior testing to eliminate unnecessary repetition.

Routine complete blood count (CBC), urinalysis, and selected tests for suspected disease are important. Urine or blood toxicology is important for drug detoxification, as well as opioid therapy.

Imaging studies

Imaging studies, including with radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning, are important tools in the workup of patients with CPS. (See the images below.)

Sagittal magnetic resonance imaging (MRI) scan of Sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus. Axial magnetic resonance imaging (MRI) scan of theAxial magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus. Osteoarthritis of the knee, Kellgren stage III. Osteoarthritis of the knee, Kellgren stage III. Oblique view of the cervical spine demonstrates 2 Oblique view of the cervical spine demonstrates 2 levels of foraminal stenosis (white arrows) resulting from facet hypertrophy (yellow arrow) and uncovertebral joint hypertrophy. T1-weighted sagittal magnetic resonance imaging (MT1-weighted sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with rheumatoid arthritis shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum, due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.
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Contributor Information and Disclosures
Author

Manish K Singh, MD  Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD  Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University

Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Rollin M Gallagher, MD, MPH  Clinical Professor, Departments of Psychiatry and Anesthesiology, Director for Health Policy and Primary Care, Penn Pain Medicine, University of Pennsylvania School of Medicine; Director, Pain Management Service, Philadelphia Veterans Affairs Medical Center

Rollin M Gallagher, MD, MPH is a member of the following medical societies: Academy of Psychosomatic Medicine and American Academy of Pain Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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Sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus.
Axial magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus.
Osteoarthritis of the knee, Kellgren stage III.
Nerve irritation in the herniated disk occurs at the root (sciatic radiculitis). In piriformis syndrome, the irritation extends to the full thickness of the nerve (sciatic neuritis).
Changes in the hand caused by rheumatoid arthritis. Photograph by David Effron MD, FACEP.
Oblique view of the cervical spine demonstrates 2 levels of foraminal stenosis (white arrows) resulting from facet hypertrophy (yellow arrow) and uncovertebral joint hypertrophy.
T1-weighted sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with rheumatoid arthritis shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum, due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.
Schematic anatomical representations, sympathetic chain and stellate ganglion.
Stellate block, important anatomical landmarks (surface and cross-sectional views).
Pertinent anatomy for lumbar sympathetic block (cross-sectional view).
Severe colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
Active endometriosis with red and powder-burn lesions; adhesions from old scarring are present.
 
 
 
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