Bring a photo ID, your insurance card, a written list of every medication and supplement with doses, and any MRI, X-ray or CT reports and discs you have. Spend ten minutes before the visit writing down when your pain started, where it goes, what makes it worse and what you have already tried. That single page does more for your diagnosis than anything else you can do.
Why preparation changes the outcome
A first pain evaluation lasts thirty to forty five minutes. How much of that goes into examining you and building a plan depends entirely on how much of it is spent reconstructing your history from memory. Patients who arrive with their records and a written account of their symptoms routinely leave with a working diagnosis. Patients who arrive empty-handed often leave with an order to obtain records, and a second appointment.
There is a second reason. Pain is subjective, and the details that distinguish one cause from another are easy to lose under the pressure of a clinical visit. Whether your leg pain is worse walking downhill or uphill separates spinal stenosis from other causes. Whether your hand goes numb at night or while driving points toward carpal tunnel. These are the details people forget to mention and then remember in the car home.
Gather your records
Collect imaging studies and, importantly, the written radiology reports that go with them. A disc alone is less useful than a disc plus the report. If the imaging was done at a hospital, most systems now let you download studies through a patient portal, or you can request a disc at the radiology department, usually free and same day.
Also bring operative reports from any previous spine or joint surgery, physical therapy notes or a discharge summary, notes from other specialists you have seen for this problem, and results of any prior injections including the date and how much relief you got and for how long. That last item is diagnostic information in its own right.
Write out your medication list
List every prescription medication with its dose and how often you take it, every over the counter product including anti-inflammatories and sleep aids, and every supplement. Supplements matter more than people expect. Fish oil, turmeric, vitamin E and ginkgo all affect bleeding, which is relevant before any injection.
Flag blood thinners explicitly, including aspirin, clopidogrel, apixaban, rivaroxaban and warfarin. These do not prevent treatment, but they change the timing and sometimes require coordination with your prescribing physician. Note any medication allergies and what the reaction actually was.
Describe your pain in specifics
- When it started, and what you were doing when it did
- Exactly where it sits, and where it travels to
- What it feels like: aching, burning, stabbing, electric, deep or on the surface
- What makes it worse and what makes it better, including position and time of day
- Its intensity at its best and its worst on a scale of one to ten
- Any numbness, tingling or weakness, and precisely where
- What you have already tried, including medication, therapy, injections and surgery, and what each one did
- What you can no longer do because of it
That last point is worth emphasizing. Function is a better measure of progress than a pain score. Being able to sleep through the night, drive thirty minutes, or get through a shift is concrete, and it is what treatment should be aimed at.
What to wear and when to arrive
Wear loose comfortable clothing that allows the painful area to be examined without a struggle. If your back, hip or leg is the problem, shorts or loose trousers work better than jeans. Avoid one-piece outfits. Arrive fifteen to twenty minutes early to finish paperwork so the clinical time is not spent on forms. If new patient forms were sent in advance, complete them at home.
Eat normally beforehand unless you have been told otherwise, and bring someone with you if you expect to have trouble retaining what is discussed. A second set of ears is genuinely useful at a first visit.
Questions worth asking
- What do you think is causing my pain, and what is the evidence for that?
- What else could it be, and how would we tell the difference?
- What are my options, in order, and what happens if I do nothing?
- How long before I should expect improvement, and how will we measure it?
- What are the risks and side effects of what you are recommending?
- Will this be covered by my insurance, and what is my share?
- Who do I call if things get worse before my next visit?
What happens during the visit
You will be asked about your history, then examined. A pain examination tests more than where it hurts: strength in specific muscle groups, reflexes, sensation in defined nerve territories, range of motion and provocative maneuvers that reproduce your symptoms. Each of these narrows the list of possible sources.
Your imaging is reviewed with you. If nerve symptoms are present, an EMG and nerve conduction study may be ordered or performed the same day. If the picture points to one structure, a diagnostic injection may be proposed, which serves as both a test and a treatment. You should leave knowing the working diagnosis, the plan, and the next date.
I would rather spend the first visit finding out exactly what is wrong than treating a guess. The guess costs more time in the end.
Practical matters
Most insurance plans do not require a referral for pain management, though some HMO plans do. NJ Pain & Spine accepts most major plans, Medicare, Medicaid, workers' compensation and auto accident coverage, and will verify your specific plan before the visit. Call (888) 233-3415 to schedule at the Clifton, Jersey City or Edison office.