PAIN DIAGNOSIS

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The most common reason people visit a doctor is because of pain.  There are up to 100,000,000 people in the US living in chronic pain, many without an accurate diagnosis.  In part, this is due to the segmented way medical training looks at pain.  Each specialty views pain primarily through the prism of 1.diagnoses they can be paid by insurers to treat and 2. diagnoses related to their own specialty area.  This means a rheumatologist primarily looks for rheumatic and connective tissue diseases and may discount diagnosis that are not covered by insurance and may miss non-rheumatic pain diagnoses altogether.  A neurosurgeon looks for surgical problems that would be amenable to insurance-covered surgery, but may not mention diagnoses that insurance does not cover, and may miss rheumatic and connective tissue diseases altogether.  Specialists lack broad training in diagnosing the most common symptom in medicine: pain.  Frequently this leads to a long journey through many specialists over several years, each coming up with a diagnosis related to their own specialty, but none may be correct.  Pain physicians with specialized fellowship training were initially thought to be a step towards coherent diagnosis but they too succumb to the whims of insurance coverage, not offering patients proven effective treatments because they are denied by insurance.  For instance, how often do patients receive a diagnosis of internal disc derangement or discogenic pain?  Only rarely are patients told this is their diagnosis by pain physicians even though studies have shown this is the most commonly seen cause for spine pain.  Insurance carriers have blocked payment for effective treatment considering anything done to the disc as "investigational" for discogenic disease.  Therefore pain physicians frequently do not discuss this diagnosis, instead moving on to diagnoses that are paid by insurance resulting in many inappropriate injections performed over and over that cannot possibly help the patient. Moreover, the past few years has seen pain physicians gravitate to the most lucrative reimbursing treatments, specializing primarily in spine injections.  Diagnosis is also obscured because pain physicians may not even take the time to look at the actual MRI or Xray images, instead relying on the radiologist interpretation of the images.  However radiologists do not examine patients nor receive more than a few words about the pain complaints, and instead may find 15 different anatomical abnormalities on the images, none of which may be related to the patient's pain. Patients receiving the radiologist' report may be panicked over findings that may have no bearing at all on their pain or outcome.  

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THE ALGOS APPROACH

Because Algos is paid the same hourly rate regardless of the diagnosis or treatment, we do not selectively gravitate to diagnosis that will produce a larger paycheck. Our fees for diagnosis are all the same.  The fees for therapy include our hourly rate plus our cost for supplies and equipment.  We do not jack up the treatment charges by 1000-2500% as do many physicians.  Therefore we equally entertain all pain diagnoses from muscle and tendon pain to cancer to serious spinal abnormalities to rheumatic diseases to referred pain to medical causes of pain. We do not focus on diagnoses that will ultimately make us more money, since none of the treatments make us any more money than another. Furthermore, Algos engages the patient in their own diagnosis by making freely available a constantly updated website that provides monographs for every source of pain in the body:  www.painbytes.com   This website has a Dx tab at the top that permits patients to click on an area of pain in the body and receive a list of possible diagnoses, with monographs on each describing in-depth the condition and associated features.  Algos also will view the MRI or X-ray with the patient if this is brought to the visit by the patient.  

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DIAGNOSTICS IN PAIN MEDICINE

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While the history and physical exam provides most of the information needed for diagnosis of pain, a standard format of presentation of this information is valuable in making an accurate diagnosis.  Patients will complete an online questionnaire that will pull together all basic questions that may help with pain diagnosis, and during the initial office visit, the responses to these questions will be explored further.  The questionnaire saves the patient time and money by avoiding redundant processes of gathering information and inputting that information into a chart format.  We also employ the following techniques to develop a list of the most likely pain diagnoses, called a "Differential Diagnosis":

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MRI    CT Scans    CT Myelograms   Ultrasound (in office)  Vascular studies (in office)  X-ray  Lab studies