History: Individuals with chronic pain syndrome describe persistent pain with subjective symptoms disproportionate to their objective findings. Individuals with chronic pain syndrome often have a history of prescription or non-prescription drug abuse, alcohol abuse, treatment by multiple medical professionals, extensive diagnostic testing and treatment, psychological disorders, and self-limitations in personal and occupational activities of daily living. A thorough history will include assessment of major organ systems, including musculoskeletal, reproductive, gastrointestinal, and urologic systems. The use of standardized questionnaires can be very helpful in gathering information about the location, quality, and severity of pain, as well as its effects on sleep and on the individual’s level of function. Risk assessment questionnaires are used as a part of history to verify the psychological and dependency risks in setting of pain management. Physicians may assess the individual for Sternbach’s 6 D’s of CPS (dramatization of complaints, drug misuse, dysfunction, dependency, depression, and disability) to establish the diagnosis.
Physical exam: Individuals with chronic pain syndrome can have normal physical examinations with no evidence of neurologic, musculoskeletal, or other impairment. Individuals with chronic pain syndrome usually exhibit expressions of pain, such as moaning, groaning, gasping, or grimacing, that are inconsistent with the absence of medical impairment. Individuals with this syndrome often exhibit so-called non-organic findings, such as little or no active range of motion but normal passive range of motion.
Tests: Individuals with chronic pain syndrome may have no abnormalities identified on diagnostic testing. However, routine blood tests and neurologic evaluation may be ordered to investigate possible underlying conditions. Psychological testing may be done, particularly if organic diseases have been excluded. A chronic pain patient should be thoroughly and periodically investigated as should any other patient. Explaining all current and future conditions of a patient by only one diagnosis of chronic pain syndrome may be misleading and dangerous.