Performing investigations in a patient with pain

It is often possible to determine the type and cause of pain without undertaking investigations. Undertake investigations only if they are necessary to confirm clinical impressions or will influence management, and review the results of previous investigations before ordering further tests. Investigations may also be considered in patients at extremes of age and patients with symptoms that may indicate serious underlying pathology (eg significant neurological deficit).

Inappropriate investigations often result in unrealistic expectations of therapy, can medicalise chronic pain, and add cost and risk for the patient.

Radiologically guided diagnostic interventions should only be performed in the context of a comprehensive pain management strategy.

Radiologically demonstrated lesions (eg facet joint arthropathy, disc abnormalities) are often poorly correlated with symptoms; findings must be interpreted in the context of history, examination and other investigations.