Pain is an unpleasant sensory and emotional perception that is usually, but not always, the result of underlying tissue pathology. It is often the initial complaint that brings a patient to the physician’s office and is the primary chief complaint in the emergency department. Diagnostic clues first appear during the history and examination of the patient; however, the history can sometimes be difficult to obtain, as pain is interpreted differently depending on the patient’s culture, language, prior experiences, the acute to chronic nature of pain, and the varied descriptions of pain.
When the primary complaint is pain, the history is often nonspecific, presenting a challenge to the clinician who is trying to determine whether the cause is benign or due to a serious illness. Pain history includes location, duration (acute or chronic), exacerbating and relieving factors, and accompanying symptoms. Understanding the neurological basis of pain is important in establishing a diagnosis and treatment plan.
This article discusses several of the most common presentations of pain that often prompt a neurology referral for further workup and will focus on common neurologic causes of pain seen in the primary physicians’ office1 (Table 1). Diagnostic testing and initial treatment for these disease pathologies will also be explored.
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-Victor C. Wang, MD, PhDa, William J. Mullally, MD, FAHSb
