DIFFERENTIAL DIAGNOSIS

Pain is the result of an abnormality or injury.  True or false?

Pain can cause pain. True or false?

It is better to treat the cause of pain. True or false?

It is better to treat pain regardless of cause. True or false?

Doctors worry about treating pain. True or false?

Believe it or not, all of the above statements are true. So, which is more important, the cause of the symptom or the symptom itself? Patients usually focus on the symptom.   “Doc, I’m having terrible spasms in my right forearm causing excruciating pain.  I need something for the pain.”  Something for the pain usually translates to hydrocodone and prescribing hydrocodone makes docs nervous.

The doc’s job is to diagnose the cause for the pain, directing treatment at removing the source.  Using hydrocodone is the equivalent of putting a Band-Aid on a cut.  Finding the cause of the pain/spasm can be difficult and often, in many cases, requires a thorough history, exam and testing.

Take, for example, my forearm pain.  I’ve been getting excruciating right arm muscle spasms causing severe pain and disability. It’s gone on for week;s and, at times, it felt like the spasm would break my bones.  Initially, I thought my deep brain stimulator was causing the spasms as the pain would go away when the stimulator was turned down.  When the pain was severe, I turned off the stimulator. The pain persisted.  Obviously, the DBS was not the cause.  Right?

Wrong.  Remember, spasm can cause spasm and my spasm had gone on for weeks.  One spasm was accompanied by a loud pop in my elbow followed by an inability to fully extend the elbow.

As you can see from my example, the diagnostic process can be difficult.  Before you see your doc for a problem, make a list of your symptoms and any possible causes.  Please do not search the internet!  According to google, everyone has cancer and other rare diseases.  On occasion, all you’ll need is a Band-Aid.  When I practiced medicine, I preferred diagnosing the cause of the pain as opposed to applying a Band-Aid. If I could diagnose and treat the origin of the symptom, then I had a chance at a permanent cure.

The next time you see the doc, remember how complex diagnosis and treatment can be.

Here’s today joke:

My wife yelled from the bedroom asking, “Do you ever get a shooting pain across your body like someone’s got a voodoo doll of you and they’re stabbing it?” I replied, “No.”

She yelled back, “How about now?”

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2 Replies to “DIFFERENTIAL DIAGNOSIS”

  1. Someone has a voodoo doll of me with way to many needles and way too much time on their hands.

  2. Hi Doc,
    Hope you can get relief, although the DBS is much different than the Neuro Stimulator, but can the DBS be adjusted to a lesser intensity. I know it is a very thin tightrope to walk, but as for my situation, a little more pain is acceptable when weighed against the undesirable effects. Again, understanding your situation is much different, it may not be a possibility, but may be worth discussing with your specialist. P.S. I hope that popping was not a tendon, you do not need that challenge.

    God Bless

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