Chapter 7

Where Are You on
the Healing Journey:
Diagnostic Phase or
Rehabilitation Phase?

As I have already mentioned, you need to have a diagnosis for your chronic pain condition before you are ready for this book. But here is a very important question: Do you trust your diagnosis? Your answer may affect how you go about making your problem better. The way you view your condition will determine your choice of treatments, as well as your commitment to practices for taking care of yourself. After all, for many acute problems, little or no self-care is needed. Break your leg? Get a cast for a few weeks and it’s fixed. Strep throat? Take your antibiotics for ten days and you should be good to go.

We’ve learned that, with chronic problems, it’s not so simple. There is usually no magic bullet for chronic pain. No medication or surgical intervention can fix the problem. In the pain medicine field, we use the terms diagnostic phase and rehabilitation phase to describe where patients are on their healing trajectory.

Diagnostic Phase

If you have chronic pain or live with a chronic pain sufferer, you are likely very familiar with the diagnostic phase. This is where you go to x number of clinics, hospitals, and specialists, trying to find out what is wrong. Your search for a diagnosis may entail physical examinations, blood tests, X-rays, CT or MRI scans, or diagnostic nerve blocks. If these tests reveal a specific structural or biomechanical problem to explain your current symptoms, then the diagnosis will call for a prescribed treatment. You may find that surgery, nerve blocks, or steroid or biologic immune-modulating medications will help your symptoms improve.

However, in the case of many chronic conditions, symptoms persist and worsen even after these diagnoses are made. Your current symptoms may persist or even get worse after the initial physical problem has been repaired. I’ve had patients who have had surgery to successfully repair herniated lumbar discs, yet their low back pain continued for years. Some patients just can’t stop looking for that magic bullet that they hope will take the problem away, and keep getting referred to more and more specialists.

Rehabilitation Phase

Fortunately, some patients get referred to a pain clinic, where the specialists are more highly trained in how chronic conditions differ from acute ones. Once a diagnosis is clarified and confirmed, the clinician will educate the patient on the need to move on from the diagnostic phase to the rehabilitation phase. This is a necessary step in the journey of healing from chronic pain.

In this phase, you know what your diagnosis is, and you accept it. You become committed to following a course of slow, steady, progressive progress in your symptoms. You no longer demand that the pain disappear completely. Instead, you adopt a more realistic goal of reducing the frequency, intensity, and intrusiveness of the pain. This reduction in pain allows you to get back to your desired activities of daily living. You have started the process of developing your own internal toolkit for healing, without depending on an external “rescue” treatment.

Over the years, I have encountered many patients with chronic pain who were not quite ready to make the transition from diagnostic to rehabilitation phase. This is the person who clings to the hope that a physical cause for their pain just hasn’t been found yet. There might still be “something missing that a third MRI might reveal.” “Maybe there’s a tumor or a growth on my spine that remains hidden.” “Maybe I have some rare autoimmune condition causing my pain that hasn’t shown up on blood tests yet.” These holdouts will have trouble truly committing themselves to the sustained effort, or enjoying the benefits, of self-care. After all, why should they bother doing stretching exercises every day if their whole problem might be solved by another surgery?

Timing Is Everything

When I meet a new patient who clearly is not ready for the rehabilitation phase, I always tell them the same thing:

“I realize that you still have the belief and hope that another diagnostic evaluation and MRI will reveal a new, specific cause for your chronic pain. From my reading of your chart and discussions with your other providers, I do not feel that additional diagnostic evaluation is needed. However, if this is your belief, then I support you to go through the additional time, expense, and effort needed to get yet another evaluation. If a new treatable diagnosis is discovered that leads to better treatments for you, that would be great. But if it doesn’t lead to new diagnoses and conclusions, I want to remind you to not be discouraged. There is another course of action, healing, and rehabilitation available for you here, when you are ready for it.”