Pain-Based Patient History (Anamnesis)
The most important tool in the diagnosis of CMD is a comprehensive and systematic patient history (anamnesis). The first requirement of course is an overall anamnesis covering the general health of the patient. Then, as part of the special pain anamnesis that follows, the patient will be asked about the nature, onset, progress and circumstances surrounding their CMD symptoms. Where does it hurt? How severe is the pain or debilitation? What kind of pain is it, e.g. a burning pain or a dull pain? When does the pain appear – is it always the same regardless of the time of day or other circumstances? Are there any factors that make the pain either more or less severe? What treatment has the patient had so far? What was the outcome? And finally, an anamnesis for chronic pain should always include some questions about the patient’s work and family situation.
It is obvious that an anamnesis of this nature cannot be completed in less than 15 minutes and, in some cases, it could take 30 to 60 minutes. It is also obvious that most doctors would probably not invest this amount of time. There are obviously economic reasons for this because any kind of talking therapy is traditionally very poorly reimbursed in Germany or is simply not covered by health insurance at all. So the actual labour time required to do an anamnesis, which is the most important diagnostic tool, must either be provided gratis by the doctor, or he would need to enter into a private fee arrangement with the patient. Besides, many doctors do not like taking a structured patient history because of their predominately somatic and, to a certain extent, rather mechanistic training. They would much rather rely on technical procedures such as X-rays, MRI or computer-aided measurement of the movement of the lower jaw. Unfortunately, most of these technical procedures are not very helpful and some of them, such as measuring the movement of a joint, are completely useless. However, there can be no realistic diagnosis without a structured pain-based patient history!
The taking of a pain-based patient history is nearly always followed by a tentative diagnosis. The way that the patient describes their pain will have already made it possible to differentiate between muscle and joint pain. The anamnesis is then followed by a short physical examination which will either confirm or modify the tentative diagnosis.