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I have been to three well-known pain clinics for my chronic back and leg pain. Everyone is very nice, and they all seem very certain they know what's wrong with me. But nothing they do for me has helped. I've had lots of tests. Sometimes the same ones repeated. Isn't there one simple way to tell what's wrong? How can it be so difficult?

Pain is a very complex event in the body. And chronic pain (pain that lasts past the usual time for healing) is an even more confounding mystery. Many, many scientists are studying ways to define it, describe it, diagnose the cause, and find ways to treat it fast and effectively. So far, there are no magic bullets. It seems that besides the physiologic and biologic basis for pain, other factors enter in to the pain experience. Social factors, emotions, personality, and the psychologic make-up of the person all enter into the formula that results in pain. As you may have experienced, managing pain often becomes a matter of trial-and-error looking for the right answer for each patient. What we really need is an evidence-based approach. One researcher has taken this idea a step in the right direction. Dr. J. Scholz, a neurologist and professor of anesthesia at Harvard Medical School has developed a test to diagnose neuropathic (nerve-related) pain from non-neuropathic pain. The test is called the Standardized Evaluation of Pain or StEP. It is a highly sensitive and specific test for telling the difference between neuropathic and non-neuropathic pain. patients are asked a series of six interview questions and given 10 simple physical tests. From this tool, it is possible to accurately assess patients' pain. That's helpful because treatment can be directed more specifically if the underlying cause can be determined. The target of therapy should not just be masking pain but should go right to the active mechanism causing the pain and put a stop to it. But to answer your question, we are far from being able to do one simple test and know for certain what's causing a person's pain and how to deal with it most effectively. This new tool is a step in the right direction. It will ultimately help pain experts predict what patient responses will be to specific treatments. Choosing a treatment right from the start that has a high chance of success is the ultimate goal in pain management.

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