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Comprehensive pain assessment

A comprehensive pain assessment is a specialist consultation that works out what is generating your pain, what has been tried, and what should happen next. It involves a thorough review of your pain and medical history, and results in a written plan sent to your referring doctor.

Persistent pain rarely has a single cause. Most people referred here have more than one contributor — a structural problem, changes in how the nervous system processes pain signals, deconditioning, poor sleep, and the effects of pain on mood and daily life. An assessment that only looks for one of these will usually reach the wrong answer.

What the appointment covers. Dr Martin will ask about how the pain started, how it has changed, what makes it better and worse, and where it is felt. He will ask what has already been tried — medications, physiotherapy, injections, surgery — and what happened with each. He will ask about function: what you can no longer do, and what you would most like to get back to. Sleep, mood and work or study are covered, because all three both affect pain and are affected by it.

Examination and imaging. A physical examination follows, focused on the region involved and on the nervous system. Any scans you have had will be reviewed. It is worth knowing that imaging findings and pain often correlate poorly — changes described on a report as degenerative are common in people with no pain at all — so the scan is read alongside the examination rather than in place of it.

What you leave with. Dr Martin will explain what he thinks is driving the pain and why. Where a diagnosis is uncertain, he will say so, and may propose a diagnostic step to resolve it. Options are discussed with their realistic likely benefit, and with what is involved. A letter goes to your referring doctor.

What will not happen. No procedure is performed at the first appointment. If a procedure is likely to help, it is planned and booked separately, so that you have time to consider it.

What to bring. Your referral, a list of current medications and doses, any imaging or reports (or the details of where they were done), and, if it helps, a short written summary of what you want from the appointment.

Sometimes the honest conclusion is that no procedure is likely to help. Where that is the case, Dr Martin will say so, and the plan will focus on the approaches that are more likely to make a difference.