Pain management doctors diagnose chronic pain by combining several tools: a detailed pain history, a hands-on physical exam, targeted imaging, nerve function testing, and diagnostic injections that directly test specific nerves. There is no single scan or blood test that proves pain exists. The diagnosis comes from matching your symptoms to a physical source, and that last tool, the diagnostic injection, is what separates a pain specialist’s workup from the evaluations most patients have already been through.
Why a Normal MRI Doesn’t Rule Out a Real Problem
If a doctor has ever pointed at a clean scan and shrugged, you already know the most frustrating part of living with chronic pain. Here is what that doctor should have told you: imaging and pain do not line up nearly as neatly as people assume. In a large NIH-published review of pain-free adults, 37% of 20-year-olds and 96% of 80-year-olds showed disc degeneration on their scans despite having no pain at all. The reverse is also true. Plenty of painful conditions, including nerve irritation and facet joint problems, can hide on an MRI entirely. A scan is one clue, not a verdict.
What a Full Pain Evaluation Includes
A thorough workup builds the case from several directions at once:
- Your pain history: Where it started, how it behaves through the day, what makes it spike, and what has already failed. The pattern often points to the source before any test does.
- A physical exam: Specific movements, reflex checks, and strength testing that intentionally reproduce your pain, because where and how that happens narrows down what is generating it.
- A fresh read of your imaging: Not just whether something shows up, but whether it actually matches your symptoms.
- Nerve function testing: When numbness or weakness is involved, a nerve conduction study measures how well signals are traveling and whether a nerve is damaged.
Diagnostic Injections: The Test Most Patients Have Never Had
This is the step that finally gets answers for people who have been hurting for years. Your physician numbs one suspected pain source, such as a single nerve or a facet joint (one of the small joints connecting the vertebrae), with a precise, image-guided injection. Then you go about your day and pay attention. If the pain vanishes while the numbing medication is active, the source is confirmed. If nothing changes, that structure is ruled out, and the search moves on.
The result is not just a label. It is a treatment map. A positive facet block, for example, tells your physician you are a strong candidate for radiofrequency ablation, which requires no surgery, no incision, and no general anesthesia, with minimal downtime.
How to Prepare for a Pain Evaluation
You can make your first appointment more productive:
- Keep a one-week pain diary, noting times, activities, and severity
- Bring every prior scan, report, and specialist note you have
- List each treatment you have tried and how long you gave it
- Write down what you want back, whether that is sleep, work, or golf
If You Have Been Dismissed Before, Start Here
Being told your scans look fine is not a diagnosis, and it is definitely not a treatment plan. Our physicians run this full evaluation, including the diagnostic injections most workups skip, at five offices across DFW. Bring your records and your skepticism to Pain & Spine Physicians. Call 972-350-0225 or contact us online to schedule an evaluation.