Pain Management Clinical Exams and Diagnostic Tests for Pain

Pain Management Clinical Exams and Diagnostic Tests for Pain

To assist with pain management and gauge your current state of health, Patients Medical will often request copies of your last two years of medical testing be sent to us for review and comparison, and we will often recommend further testing as needed. Our center does request some testing that is not commonly performed in more mainstream medical centers. Because we take a whole-person approach we may recommend evaluation of bodily systems through food sensitivity testing, neurotransmitter analysis, heavy metal testing, comprehensive stool testing, or Candida antigen testing, for example, to seek further upstream for the origins of imbalances in the body.  Some of these are discussed in detail in this section.

What to Expect on Your First Visit at Patients Medical Center

The first office visits typically last 45-60 minutes. Your physician will review your intake form with you and gather a detailed medical history. A partial physical exam is usually performed and medical records are often requested from your primary care physician and/or other physicians.  Specialty laboratory testing may be recommended. Most patients are offered an initial protocol consisting of nutritional supplementation, dietary and lifestyle recommendations.

Blood Test

Blood tests may be recommended to assess and identify kidney, liver, blood sugar and other key factors such as blood cholesterols. The results are explained to the patient, giving him/her a fuller understanding of the blood chemistry, so that they may take control.

Patients may be required to fast for 14 hours before the test. Water may be consumed freely, but not tea, coffee, juices or other beverages. Appointments are normally arranged for mid-morning so that food and drink can be consumed up until 8:00 p.m. the prior evening. On the day of the appointment, any prescribed medication should be taken with water as normal.

Patients are recommended to bring food to eat after the blood sample has been taken. Diabetics should advise the center, and separate arrangements will be made.

Urine Analysis

Urinalysis may be recommended to evaluate for pH, urinary metabolites, or establish kidney functioning. Patients may be required to collect urine over a period of 24 hours. This should be collected as near to the date of the blood test as possible, but must not include the 14-hour fasting period prior to the appointment.

You will receive specific instruction for a 24-hour urine assessment, but our generally recommended timetable is that the first urine of the day should be excluded, then all subsequent urine for the next 24 hours collected in clean plastic containers. If collection starts at 8:00 a.m. this process must be followed until 8:00 a.m. the following day. For example, if you have been scheduled for a 10:00 a.m. Friday appointment, then fasting commences Thursday at 8:00 p.m. Urine collection starts Wednesday 8:00 a.m. and proceeds until Thursday 8:00 a.m.

Containers should be clearly labeled with the patient's full name and brought to the center at the time of their appointment.

Resting ECG for physicians Report (dependent upon the patient's individual circumstances)

The electrocardiograph (ECG) determines the condition of the heart and measures its actions and the pulse.

The physician in charge reports any findings in his medical notes.

Specific Pain Management Testing

Traditional Diagnostic Testing:

Traditional Chinese Medicine (TCM). There are four main methods of observation that help the practitioner to assess the patient's condition and arrive at a diagnosis and treatment plan: observing signs in the patient (in the voice, tongue, posture, gait, skin, hair, nails, eyes); observing the patient's odors; asking about their background and details of their life; and, lastly, touching. Touching is generally considered the most important and relates to methods for evaluating the flow of energy—qi—through the channels of the meridian system of acupuncture points, trigger points, and meridian alarm points, as well as the Chinese method for interpreting signals from the different pulse positions on the wrist, taken at different levels of pressure by the physician. Signals from each position at each pressure level provide clues to balance or imbalance between energies at work in the body.

Ayurvedic Medicine. Several techniques are used to determine the state of balance between the patient's three doshas and elucidate underlying contributors to their health concerns. The barometers of patient diagnosis in Ayurveda are threefold: seeing and observation (darshana); enquiry through questioning (prashna); and again, touching (sparshana). In the hands of an experienced Ayurvedic practitioner, pulse diagnosis is deeply revealing of the energetic state of individuals aspect of the body as well as the person's whole being.

Traditional nonintrusive diagnostic methods such as these, alone or in conjunction with newly emergent diagnostic methods of these ancient traditions, or in combination with conventional quantitative testing, allow for an integrative analysis of a patient's complaints.

Nonintrusive techniques common to more recently developed integrative practices such as osteopathy and the chiropractic profession can also be revealing of underlying problems and conditions. Applied kinesiology evaluation may help to determine the functional health status of the body through muscle response testing (MRT) and/or autonomic response testing (ART). Structural assessment of the musculoskeletal system may help identify imbalances or misalignments that may have physiological or pathological consequences. Kinesiology evaluation techniques aid the practitioner in assessing the three functional aspects of a patient's entire well-being: biomechanical (structural); biochemical; and emotional.

Conventional Lab Tests:

Lyme Disease. If caught early enough, infection with Lyme disease can be straightforward to diagnose by identifying the tick bite, the characteristic target-shaped rash, and flu-like symptoms. If, however, the bite and rash go unnoticed, or the rash fails to develop as is generally common, the diagnosis can become much more difficult. The preliminary test consists of IgM and IgG antibody blood tests. If the tests are negative but symptoms persist, the test may be repeated. If the initial tests are positive, a Western blot test for detecting specific Lyme proteins can be performed to confirm results.

ANA. The antinuclear antibody test is useful in screening for autoimmune disorders, such as systemic lupus erythematosus (SLE). Symptoms that might indicate a suspected autoimmune condition include but are not limited to low-grade fever, joint pain, fatigue, and unexplained rashes that may change over time.

CRP. The test for C-reactive protein is a marker for the presence of inflammation. CRP is often used as an indicator of infection following surgery, but also as an indicator of inflammatory disorders such as arthritis, inflammatory bowel syndrome, and autoimmune disorders, as well as progression of metabolic syndrome. The newer high-sensitivity CRP—hs-CRP—is the preferred form of testing for this marker at Patients Medical.

ESR. The erythrocyte sedimentation rate (ESR), commonly referred to simply as "sed rate" or sedimentation rate, is another indirect, or nonspecific indicator of inflammation in the body. It can also be useful for monitoring a patient's response to therapy in certain inflammatory diseases.

RF or RhF. The test for rheumatoid factor is used to detect autoantibodies found in patients with rheumatoid arthritis, and to distinguish it from other types of arthritis.

Uric Acid Levels. This test determines levels of uric acid in the blood. High levels of uric acid may indicate gout. They have also been associated with inflammatory/metabolic disorders. Uric acid levels may be monitored following chemotherapy or radiation treatments. Signs of failing kidneys include high uric acid levels.

B-complex Vitamins. Deficiency in vitamin B12 or folate (B9) can result in anemia and the decreased ability of red blood cells to carry oxygen. Weakness, shortness of breath, and lightheadedness may be signs of B vitamin deficiencies. B12 deficiency can lead to nerve pain, nerve damage resulting in tingling in the extremities, and changes in cognitive abilities ranging from confusion and irritability to dementia. Folate deficiency in pregnancy can lead to premature birth and birth defects. Folate status may also suggest the presence of a variant of the MTHFR gene, which can predispose individuals to a number of health concerns.

Insulin. Several types of tests are available to help diagnose disorders of insulin regulation, including hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar). If blood work shows low glucose results, an insulin test may be ordered to determine level of insulin resistance, or other conditions affecting insulin levels.

Cortisol. Abnormal 24-hour cortisol levels may indicate adrenal disorders ranging from the subcenteral, such as cortisol dominance or adrenal fatigue, to serious, life-threatening conditions: Cushing's syndrome associated with high cortisol levels, and Addison's disease associated with low levels. Adrenal conditions involve major chemical signaling processes of the HPA axis of the endocrine system. Cortisol is a stress hormone involved with carbohydrate, protein, and fat metabolism. It affects glucose levels in the blood, is an anti-inflammatory agent, and an important stress regulator. Dysfunctions related to cortisol production can result in improper metabolism, weakness, dehydration, and problems regulating blood pressure and the stress response.

Testosterone (T). One of the major sex hormones in both men and women, abnormal testosterone levels help diagnose infertility and erectile dysfunction, premature or delayed puberty, virilization in women (the appearance of masculine physical characteristics), and hirsutism in women (male hair growth patterns). Testosterone is a marker for polycystic ovary syndrome (PCOS) in women, a syndrome involved in infertility and characterized by the excess production of male hormones.

Estradiol (E2). Used to help diagnose abnormal menstrual cycles, infertility, and symptoms of menopause. It is sometimes evaluated during pregnancy to monitor the status of the mother's placenta and that of the fetus. Estrogen can play an anti-inflammatory role in the body—though not always.

Progesterone (P). Levels of progesterone vary throughout the menstrual cycle, as well as across the course of a woman's life. This test is used to measure factors that can indicate infertility or ovulation, or to monitor the success of induced ovulation. In combination with other tests, progesterone testing may help diagnose abnormal uterine bleeding in non-pregnant women. Appraising the ratio of progesterone to estrogen is also of value in evaluating overall hormonal balance.

Insulin-like Growth Factor-1. IGF-1 testing is used to help diagnose deficiencies or excesses in human growth hormone (HGH). Slow growth and development in children or decreased muscle strength and increases in lipid production in adults suggest low production of IGF-1 and HGH. Excesses in IGF-1 or HGH can manifest as abnormal growth, gigantism, in children and acromegaly in adults. Acromegaly involves adult growth resulting in enlargement of hands and feet, and changes in facial features.

Heavy Metals. Panel tests that screen for suspected acute or chronic exposure to heavy metals commonly include individual or combination panels for lead, mercury, arsenic, cadmium, and chromium. The decision to test for heavy metals is based on suspected exposure from occupation, past time activities, or from centeral symptoms.

Neurotransmitters. A neurotransmitters test checks for the level of neurotransmitters (serotonin, dopamine, epinephrine, norepinephrine, and possibly others) in the body. These neurotransmitters are required for proper brain function, and suboptimal or deficient levels can cause or exacerbate emotional and physical health problems, including dysregulation of mood, stress response, and pain perception.

Begin Your Journey to Wellness with Patients Medical

The effects of chronic pain can range from simple annoyance to debilitating and life-changing. Regardless of where you might find yourself on this spectrum of pain, the practitioners at Patients Medical offer a broad range of pain management therapies derived from modern and ancient traditions in the healing arts. Our integrative approach tackles your pain problem holistically, addressing the mind-body-spirit components of pain to help you manage your pain and live a full, satisfying life.

Begin Your Healing with Patients Medical

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