T76. Should we refer patients with pain for electromyography?

Abstract

Electromyography and nerve conduction studies (EMGs) are performed for a variety of symptoms, pain being a common one. As pain is beginning to be better understood, it is important to realize whether and when pain is an appropriate justification for an EMG referral. To our knowledge, there has never been a U.S. study at a major academic center evaluating pain as a referral diagnosis for EMG studies. Pain is a significant cause of increased healthcare costs and patient visits. This study looks to evaluate whether subjective pain in a patient is suggestive of a certain diagnosis that can be discerned by EMG, or if pain is more likely to result in a normal or inaccurate referral. EMGs are painful and time-consuming as is, and decreasing the burden on patients would benefit payers and providers as well. Greater selectivity for EMG referrals when pain is a referral diagnosis could increase the efficiency of the diagnostic exam and improve patient outcomes. In this study, a retrospective chart review examined six months of patient referrals (n = 602) to an academic medical center. Data collected included referral questions, symptoms, and diagnoses. Symptoms were categorized and we define pain as ‘pain’, ‘ache’, or ‘burning’. Pins and needles were not considered pain. Only 496 patients referred had symptoms described in the referral and of those, 184 (37.1%) had pain. If a patient had pain listed as a symptom 36.4% of the time the test returned normal. For the 63 patients for whom pain was listed as the only symptom, 26 (41.2%) had a normal result. Overall, 31.9% of all referrals had normal results. For other specific symptoms, weakness was normal 27.2%, atrophy 29.4%, and paresthesias 36.9% of the time. The most common diagnosis with pain was carpal tunnel syndrome (though this is frequent overall), followed by lumbosacral and cervical radiculopathy and then peripheral neuropathy. Pain is a symptom in more than a third of patients referred for EMGs, though it resulted in a normal diagnosis over a third of the time. This symptom does not result in a diagnosis on EMG more frequently than other symptoms. Since this test can be painful, costly, and time-consuming, it is important to evaluate whether patients with pain have other symptoms or just pain alone and taking a second look at EMG referrals involving pain may help make EMG referrals more efficient.