Kindness Is the Baseline, Not the Achievement | The Pained Brain, Chapter 19

Questions to ask a pain doctor

Questions to Ask a Pain Management Doctor About Your Numbers

Ask what is generating the pain, whether your A1c, sleep and mood have been checked, and how the two of you will measure whether treatment worked. Those answers come from numbers, not from a clinic’s star rating.

Online stars grade how a visit felt. They cannot see a blood sugar in the prediabetic range, a sleep disorder nobody tested for, or a hip hiding behind back pain.

Most people choose a pain clinic the way they choose a restaurant, and the stars they trust were never designed to see inside a body. The questions to ask a pain management doctor are the ones a rating cannot answer: what is generating the pain, what else in your body is feeding it, and how anyone will know whether treatment worked. Chapter 19 of The Pained Brain by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Dr. KrisJay Fucanan, MD, is the subject of the video above, Kindness Is the Baseline, Not the Achievement. The studies behind each figure here, with their limits, are in the book companion for chapter 19.

What can a star rating not tell you about a pain doctor?

Across 614 heart surgeons, ratings averaged 4.4 of 5 whether a surgeon’s bypass death rate sat in the best quartile or the worst. Reviews of pain physicians rise on words about courtesy and fall on words about waiting, time and pain that did not go away. The reviewers are honest. They grade what they saw, which is how the front desk and the doctor treated them. Nobody can grade a blood test that was never drawn or a sleep problem nobody asked about.

So a five-star clinic can be a pleasant place where the drivers of your pain go unmeasured for years. The composite patient in the book had eleven visits in fourteen months, three injections and a satisfaction survey every time, and nobody examined his hip, checked a fasting insulin or asked how he slept.

What does a short pain visit usually miss?

The average primary care visit, measured from electronic record time stamps, lasts 18.0 minutes. In videotaped visits, doctors covered about six topics and spent roughly 1.1 minutes on each one after the largest. That arithmetic is an economic driver of missed disease: whatever is not the chief complaint gets a minute, and the questions that uncover sugar, sleep and mood are the first to fall off the schedule.

Blood sugar. One hand clinic tested the A1c of 84 patients with problems such as trigger finger and carpal tunnel syndrome. In 58.3 percent the result was in the prediabetic range, and 43.4 percent of patients with an abnormal result had no primary care provider at all.
Sleep. Among chronic pain clinic patients on opioids who completed an overnight study, 58.8 percent had sleep apnea. Among 90 people referred for high-impact chronic pain, 51.1 percent had it, and they looked no different from the rest on pain, disability or sleepiness.
Mood. Pooled across 376 studies of adults with chronic pain, 39.3 percent had clinically significant depressive symptoms and 40.2 percent had anxiety symptoms.

The first two are biological engines. Chronically high glucose and insulin keep tissue in the low-grade, body-wide inflammation the book calls metaflammation, and untreated apnea fragments sleep night after night, which leaves a sensitized nervous system no chance to settle. Neither shows up on a pain scale.

Why a normal-looking person still needs numbers

On NHANES 2009–2016, under 12.2 percent of American adults counted as metabolically healthy; on the stricter criteria used after 2021, the share drops under 7 percent. In our own clinic population the share is under 3 percent overall and under 1 percent among chronic pain patients. These figures are practice-reported, drawn from our own population, not trial outcomes, and individual results vary. The point is that looking fine and measuring fine are different claims. Dr. Padda admits he spent years telling patients with a borderline A1c that it was not too bad, reading the number as reassurance instead of as a warning. Unmeasured is unmanaged, and misread is not much better.

How does a doctor find where the pain is coming from?

In one spine surgeon’s clinic, 17.5 percent of 200 back pain patients had hip or sacroiliac joint disease alongside the spine, and 8 percent had it instead of any spine problem. Of 286 people sent on to a tertiary center, only 12 percent left with the same diagnosis they arrived carrying. Finding the generator is done with hands, history and, when needed, a diagnostic injection. Measura [Cardiometabolic and Autonomic Health Analysis] is a testing service; it measures, it does not treat, and no reading it produces can tell anyone which joint or nerve is the source. Any clinic that promises a blood test will locate your pain is selling something.

What tests should you ask a pain doctor about?

What Measura can do is put numbers on the terrain around the pain, with every result sent to your physician to interpret.

Laboratory panels, the blood work where markers such as A1c and fasting insulin belong.
Bioimpedance body composition, which separates muscle from fat so the scale does not stand in for metabolic health.
Heart rate variability, a reading of autonomic tone, the balance between the stress and recovery sides of the nervous system.

Apnea is confirmed by an overnight sleep study, performed outside Measura. Screening for depression and anxiety belongs with your physician or a behavioral clinician. A good workup also rules things out: screening 62 fibromyalgia patients for celiac disease found no cases, and vitamin D did not independently predict regional musculoskeletal pain in 349,221 UK adults once other factors were adjusted. For what insulin trouble looks like before a diagnosis, read what insulin resistance looks like before diabetes.

Questions to ask a pain management doctor

What do you believe is generating my pain, in a sentence I can repeat? Back pain patients who were unsure of their diagnosis carried more depression and disability than patients who felt certain, even with equal pain.
What is my A1c, and has anyone measured fasting insulin?
Have I been tested for sleep apnea with a study, not just a questionnaire?
Which tests are you choosing not to order, and why?
How will we know this worked, and when will we check? Researchers call a 30 percent drop in pain meaningful, while 110 pain clinic patients asked to define success named 56 percent. Agree on the target at the start.

Kindness still matters. Among 1,023 Scottish patients, high physician empathy carried odds of 5.7 for symptom improvement against 20.1 for satisfaction, which is exactly why a satisfied patient is not proof of an effective plan. Bring the list to your next appointment, use how to prepare to organize your history, and when the question becomes whether the pain is a nerve or a joint, read nerve pain after knee replacement.

Frequently asked questions

Are online reviews a good way to choose a pain doctor?

They tell you how an office treats people, which is worth knowing. They do not tell you whether the doctor finds causes. Ratings of 614 heart surgeons were the same across every mortality quartile, and pain physician reviews track courtesy and access. Use reviews for the experience, then judge the care by the diagnosis and the measurements. A fuller list lives on questions worth asking your doctor.

Why would a pain doctor care about my blood sugar?

Because it changes the terrain the pain lives in. In one hand clinic, 58.3 percent of patients with tendon and nerve-entrapment problems had an A1c in the prediabetic range, and many had no primary care provider. High glucose and insulin feed the low-grade inflammation that keeps tissue sensitized. The connection is laid out in chronic pain and metabolic health.

Can Measura tell me what is causing my pain?

No. Measura measures metabolic, autonomic, vascular, body composition and cognitive function, and sends results to your physician. It cannot identify which joint, disc or nerve is generating pain; that takes an examination and sometimes a diagnostic injection. What testing adds is the picture of the body around the pain. The limits of any single number are explained in what a test result can and cannot tell you.

Should I ask for a sleep study if I have chronic pain?

It is a fair question to raise with your physician, especially if you take opioids. Among chronic pain clinic patients on opioids who completed a study, 58.8 percent had sleep apnea, and questionnaires missed many cases in a separate group referred for high-impact pain. A sleep study is done elsewhere, not by Measura. Related symptoms are described on autonomic symptoms.

What happens to my results after testing?

Every result goes to your physician, who interprets it alongside your history and examination and decides whether anything changes. Measura does not diagnose disease on its own or recommend treatment. Bring your own questions to that conversation, including which numbers moved since the last check. How reports are organized is covered in understanding your results.

How do I prepare for a pain management appointment?

Write your questions down before you go. The average primary care visit lasts about 18 minutes, and anything that is not the chief complaint gets roughly a minute. Bring the list on this page: what is generating the pain, your A1c and fasting insulin, whether a sleep study was ever done, and how the two of you will measure success. Agree on that target at the start.

How will I know if pain treatment is working?

Agree on a number before treatment starts. Researchers call a 30 percent drop in pain meaningful, but when 110 pain clinic patients were asked to define success, they named 56 percent. That gap is why the target, and the date of the next check, belong in the plan from the first visit instead of being guessed at months and several injections later.

Can back pain actually come from the hip?

Often enough to check. In one spine surgeon’s clinic, 17.5 percent of 200 back pain patients had hip or sacroiliac joint disease alongside the spine, and 8 percent had it instead of any spine problem. Finding the true source takes hands, history and, when needed, a diagnostic injection. No blood test, and no Measura reading, can tell anyone which joint or nerve is the source.

Bring numbers to your next pain visit

Ask about metabolic labs, body composition and autonomic testing before your next pain appointment. Measura sends every result to your physician.

Send a message

4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Send your name and number and we will call you back.

References

Heiting, C., Wickes, C. B., Katakam, S., Herrera, C., Li, B., Intravia, J., Nolan, J. E., & Nellans, K. W. (2026). Occurrence of Undiagnosed Diabetes Mellitus With Musculoskeletal Disorders of the Upper Extremity: Prospective Screening With Point-of-Care Haemoglobin A1c Fingerstick Testing. Musculoskeletal Care, 24(3), e70256. https://doi.org/10.1002/msc.70256
Chung, F., Wong, J., Bellingham, G., Lebovic, G., Singh, M., Waseem, R., Peng, P., George, C. F. P., Furlan, A., Bhatia, A., Clarke, H., Juurlink, D. N., Mamdani, M. M., Horner, R., Orser, B. A., & Ryan, C. M. (2019). Predictive factors for sleep apnoea in patients on opioids for chronic pain. BMJ Open Respiratory Research, 6(1), e000523. https://doi.org/10.1136/bmjresp-2019-000523
Larsen, D. B., Bendix, L., Abeler, K., Petersen, K. K., Sprehn, M., Bruun, K. D., Blichfeldt-Eckhardt, M. R., & Vaegter, H. B. (2021). Obstructive sleep apnea is common in patients with high-impact chronic pain – an exploratory study from an interdisciplinary pain center. Scandinavian Journal of Pain, 22(1), 106–117. https://doi.org/10.1515/sjpain-2021-0112
Aaron, R. V., Ravyts, S. G., Carnahan, N. D., Bhattiprolu, K., Harte, N., McCaulley, C. C., Vitalicia, L., Rogers, A. B., Wegener, S. T., & Dudeney, J. (2025). Prevalence of Depression and Anxiety Among Adults With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Network Open, 8(3), e250268. https://doi.org/10.1001/jamanetworkopen.2025.0268
Sembrano, J. N., & Polly, D. W. (2009). How often is low back pain not coming from the back? Spine (Phila Pa 1976), 34(1), E27-E32. https://doi.org/10.1097/BRS.0b013e31818b8882
Okike, K., Peter-Bibb, T. K., Xie, K. C., & Okike, O. N. (2016). Association Between Physician Online Rating and Quality of Care. Journal of Medical Internet Research, 18(12), e324. https://doi.org/10.2196/jmir.6612
Neprash, H. T., Everhart, A., McAlpine, D., Smith, L. B., Sheridan, B., & Cross, D. A. (2021). Measuring Primary Care Exam Length Using Electronic Health Record Data. Medical Care, 59(1), 62–66. https://doi.org/10.1097/MLR.0000000000001450
Tai-Seale, M., McGuire, T. G., & Zhang, W. (2007). Time allocation in primary care office visits. Health Services Research, 42(5), 1871–1894. https://doi.org/10.1111/j.1475-6773.2006.00689.x
Robinson, M. E., Brown, J. L., George, S. Z., Edwards, P. S., Atchison, J. W., Hirsh, A. T., Waxenberg, L. B., Wittmer, V., & Fillingim, R. B. (2005). Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective. Pain Medicine, 6(5), 336–345. https://doi.org/10.1111/j.1526-4637.2005.00059.x
Serbic, D., & Pincus, T. (2014). Diagnostic uncertainty and recall bias in chronic low back pain. Pain, 155(8), 1540–1546. https://doi.org/10.1016/j.pain.2014.04.030