Why Chronic Pain Patients are Misdiagnosed 40 to 80% of the Time?

Hendler, Nelson

doi:10.5005/jp-journals-10046-0051

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…One study has found that the diagnosis of chronic pain was overlooked by referring physicians in 66.7% out of 60 cases, which included peripheral nerve entrapment, radiculopathy, and TOS ( 219 ). Similar chronic pain studies revealed that 40% to 80% of patients were misdiagnosed ( 220 ). Misdiagnosis in chronic pain is a challenging, complex problem ( 221 , 222 ) that may be influenced by etiological uncertainty of this disorder as well as by relevant diagnostic bias and inertia.…”

Section: Implications For Chronic Pain Managementmentioning

confidence: 94%

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Macionis¹

2023

Front. Pain Res.

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It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.

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Section: Implications For Chronic Pain Managementmentioning

confidence: 94%

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Macionis¹

2023

Front. Pain Res.

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“…First, considerations for Lune's physical and mental health challenges, and whether Lune might be eligible for reasonable accommodations (per the Americans With Disabilities Act [ADA]), are warranted. Studies suggest that chronic pain is often misdiagnosed (estimates of 40%-80% of patients; Hendler, 2016). Additionally, experiences of pain are more often underestimated and less likely to be treated for patients with diverse identities, including racial/ethnic diversity, gender diversity, and low socioeconomic status patients (e.g., Samulowitz et al, 2018;Summers et al, 2021;Trawalter et al, 2016).…”

Section: Vignette 6: Adapting To Chronic Painmentioning

confidence: 99%

Troubleshooting common pitfalls.

Hunter¹,

Schwartz‐Mette²

2023

Supporting Trainees With Competence Problems: A Practical Guide for Psychology Trainers.

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The following hypothetical vignettes are intended to illustrate brief examples of some of the potential trainee competence issues that trainers may encounter. Each is followed by a summary discussion, highlighting policy/procedural, legal, ethical, and remediation considerations, along with considerations for approaching each situation from a communitarian and multicultural perspective. We also attempt to highlight common reactions from trainees and trainers as a way to help prepare trainers for the process as well as content variables that may present themselves in these or similar situations.These vignettes and subsequent discussions are not meant to be exhaustive descriptions of all the aspects of a certain case or all the considerations and actions that could or should be taken. Nor are they intended to serve as direct guidance (legal or otherwise), no matter how similar they may be to real situations programs may be currently navigating. We hope, instead, that these vignettes serve as a starting point for proactive reflection and discussion, in the hopes that doing so better prepares you and your system for supporting students who are struggling with competence problems. Finally, each vignette-including names, identities, descriptions, and actions-is fictional.

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“…Despite pain being one of the most common medical complaints, many patients still suffer from untreated or undertreated pain [11]. Approximately 100 million adults (or roughly 30% of adults) suffer from pain, with a misdiagnosis rate of up to 40-80% for chronic pain patients [12,13]. Pain can negatively impact quality of life when left untreated and can progress from an acute to a chronic condition, which results in considerable morbidity and mortality [14].…”

Section: Introductionmentioning

confidence: 99%

Characteristics Associated with Multimorbidity among Older United States Adult Opioid Users with Pain

Axon,

Grieser

2023

JCM

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The objective of this study was to investigate the variables associated with multimorbidity status among older United States (US) adults with self-reported pain and opioid use. This study used a cross-sectional retrospective database design that included US adults aged ≥50 years with self-reported pain who used an opioid in 2019 in the Medical Expenditure Panel Survey data. Multivariable logistic regression models, weighted to produce nationally representative estimates, were used to determine variables significantly associated with multimorbidity status (≥2 versus <2 chronic conditions). Significance was determined using an a priori alpha level of 0.05. In the adjusted logistic regression analysis, those aged 50–64 (vs. ≥65 years), Hispanic (vs. non-Hispanic), employed (vs. unemployed), and who performed frequent exercise (vs. no frequent exercise) were associated with lower odds of having multimorbidity. In conclusion, these characteristics may be targets for pain management and opioid use interventions among older US adults. Further research is needed to investigate the variables associated with multimorbidity in greater detail.

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Why Chronic Pain Patients are Misdiagnosed 40 to 80% of the Time?

Cited by 7 publications

References 17 publications

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Troubleshooting common pitfalls.

Characteristics Associated with Multimorbidity among Older United States Adult Opioid Users with Pain

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