Background: Chronic pain accounts for 15–20% of physician visits and represents a large burden of disability. Due to the complex aetiology of chronic pain conditions, diagnosis can be challenging. This study evaluates the role of a pain management service in establishing diagnoses for its patients and provides evidence for associated outcome benefits.
Methods: One hundred patient charts from one pain management practice in Limerick, Ireland were selected at random (October 2018). Patient demographics were recorded, as well as information regarding initial diagnosis, whether pain clinic changed/established the diagnosis, how this change was accomplished, and whether patients who had a change in diagnosis had an observed outcome benefit.
Results: Pain clinic involvement changed the primary diagnosis for 32% (32/100) of patients. Targeted clinical examination was most commonly helpful in establishing a new diagnosis (69%, n=22), followed by diagnostic injection (66%, n=21) and imaging (25%, n=8). Of these patients, 87% (28/32) had a clear outcome benefit; 75% (24/32) had a quality-of-life improvement, 19% (6/32) decreased their analgesics, 16% (5/32) were referred for definitive treatment, and 72% (23/32) were discharged due to symptom resolution. Most patients had multiple benefits.
Conclusions: A significant proportion of chronic pain diagnoses were changed through involvement of the pain service, and most patients benefited from the change. This illustrates the importance of diagnosis in chronic pain and the role that the pain management service can play in this process. This study demonstrates the need for early involvement of the pain management service as well as the need for refinement of diagnostic skills and techniques.
