The single most important aspect for a musculoskeletal pain physician whether you have low back pain, neck pain, joint pain, nerve pain or muscle pain or a combination of problems is to properly identify the cause or causes of pain (pain generators), until that is achieved the Physician will be treating symptoms (pain) and not the underlying problem, the sooner it can be done, the sooner a specific treatment can be established for the patient.
We spoke in the past about the different types of pain and how to recognize them: Nociceptive, Neuropathic, Visceral.
The challenging part is when the patients have more than one pain generator. This is a very common challenge. There are several conditions that may present at the same time, causing either different types of pain, or pain in overlying areas that may confuse the picture.
It is very common to hear of a patient going to a pain clinic or spine clinic and fail initial treatment, eventually get surgery, and still afterwards have to go back to the pain clinic for chronic management.
Careful evaluation of many of those cases showed that patients had more than one pain generator, and until those are addressed as well, the pain will not be well controlled.
I truly believe that properly and promptly identifying the pain generators is the single most important part of the initial process of treating a patient with pain, and the experience and knowledge of the musculoskeletal physician will make a difference in many cases between success and failure.