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Is Chronic Pain Over Investigated?

Is Chronic Pain Over Investigated?

Pain demands immediate attention and treatment. Severe intractable chronic pain causes severe limitations in activities. Chronic intractable pain is one of the major sources of debilitating disease observed in developed countries. Pain caused by cancer or non-cancer diseases are often severe and intractable. Pain is provoked by irritation of pain receptors or sensory nerve fibers. Acute and chronic pain demands pain relief and treatment. In recent years choice of investigations to diagnose chronic pain has multiplied and cost of investigation has exponentially increased.

Is Chronic Pain Over Investigated?

Why in Few Cases Pain Become Long Term and Severe?

Cancer Pain:

Primary or metastatic cancer tissue triggers pain by encroaching receptors or nerve fibers. Pain becomes long term since cancer is often non-curable disease.

Non-Cancer Pain:

  • Inflammation – Chronic non-cancer pain is caused by superficial and deep tissue inflammation. Inflammation results in release of neurotransmitters, which irritates nerve receptors and nerve fibers.
  • Scar Tissue – Healing of inflammation, injuries and surgery follows scarring of inflamed tissues. Permanent scarring causes long-term irritation of nerve fibers and receptors.
  • Trauma – Other causes of non-cancer pain are nerve injury, tissue trauma, muscle damage or post surgery scarring. Tissue trauma causes scarring of surrounding tissue, scar tissue often causes squeeze or pinch of sensory nerve or irritation of nerve fibers resulting in severe pain.
  • Pinch Nerve Pain – Pain caused by pinch or squeeze of sensory nerve causes severe pain with activities. Pain becomes long term if irritation of pain receptors and nerve fibers continue, even after disease is treated.

Is Chronic Pain Aggressively Investigated?

Complaint of chronic pain follows multiple physician consultations, references, and investigations. Fear of failure to treat the cause of chronic pain results in aggressive attempt to investigate and treat the cause of pain. Patient suffering with intense pain wants immediate results. Patient will change physicians frequently, which results in duplication and revision of same investigation. An Impatient patient will try multiple specialists and multiple treatments in short period of time. Yes, chronic pain is aggressively investigated.

Why Investigations or Tests are Repeated?

Physicians, hospitals and facilities, which are performing investigation, do not freely share hard copies or reports. Patient’s reports are confidential documents and protected by care provider. Physician’s office, hospital and facilities performing investigations do not share information if care provider is not affiliated with any one of these institutions.

Why Some of the Investigations and Medical Information are not Freely Shared Among Care Provider?

Institutions and treatment provider in USA are constantly under fear of legal consequences. Legal disputes are initiated when chronic pain patient is inadequately treated or information is shared without patient’s written consent. In USA patient’s written consent is necessary to release any information of ongoing treatments or investigations. Most of the patients are reluctant to give written authorization because of fear of hidden clauses forcing out of pocket expenses. Hard copies and reports of investigations are sometimes withheld because of fear of losing the patient to a different care provider or facility.

Why Some of the Investigations are Frequently Repeated?

Repeated Investigation - MRI

Primary care physician, specialist and ER physician repeat investigations.

Primary Care Physician (PCP) – Patients usually consult primary care physician for pain treatment. Initial consultation is often followed by investigation. PCP will continue treatment as long as treatment is effective and responds. Patient will be referred to specialist for further treatment, if pain is not responding or further evaluation is necessary.

Specialist – Patient is given a choice to see a specialist affiliated with same hospital so all the investigations and information are shared with less legal hassles. Most of the patients often prefer to see a specialist of their choice or suggested by friends and families. If the specialist is affiliated with another health service provider, then acquiring past medical records from other physicians and facilities become difficult. Medical records, investigation reports and hard copies may not be available for several days or weeks. Past experience of legal issues and unnecessary medico legal action had established apprehension among physicians and facilities. Reports and hard copies of investigation will not be dispatched or emailed until patient signs the agreement to release these documents. The process of obtaining permission from patient can take several days to weeks and delays delivering of these documents. Physician will repeat the investigation than to wait for several days if symptoms and signs are serious and may cause serious damage to patient.

Emergency Room (ER) Visit – Patient suffering with chronic pain often visits Emergency Room or Urgent Care for treatment. Change of symptoms or signs of chronic pain requires urgent evaluation and investigation to rule out life threatening complications. Investigations are repeated to establish prognosis or progress of the disease. Investigations often repeated are blood examinations, X-ray, CAT scan, MRI, nerve conduction studies, ultrasound studies and electromyogram.

Is it Necessary to Repeat Investigations?

Investigations are performed to diagnose the cause of pain and later to observe the progress of the diseases. How often investigations should be repeated depends on severity of symptoms and disease causing symptoms. Intolerable pain, sudden increased intensity and change in characteristic of pain suggest further investigation and test are necessary. Repetition of investigation can be avoided if previous investigations are available to see for a treating physician or ER physician in reasonable time. Change in symptoms and signs demands immediate investigation and diagnosis to mandate immediate suitable treatment. Investigations are repeated because of patient’s demand to achieve better treatment, physician’s fear of legal dispute if failed to provide appropriate treatment and health provider reluctant to share information.

How Can Cost of Investigation be Reduced?

Investigations are indicated in several cases for diagnosis and to determine progress of the disease. Prognosis or disease worsening are measured by change of severity of symptoms and sign. Investigations may need to be repeated every 4 to 6 months depending on cause of the pain. You will eliminate duplicate investigation by providing all the reports during your office visit or hospital admissions.

What Can I do to Avoid or Exclude Unnecessary Investigations?

You have the right to own hard copies of all tests and reports of all investigation. You should possess original hard copies and reports of MRI, CAT scan, X-ray pictures, and ultra sound. You should carefully save reports and copies of all investigations at home. You should carry these reports to specialist and ER as and when necessary. You should bring them back and keep at home after every follow up visits. Physician will not request further investigation if not necessary.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:June 5, 2018

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