Back pain & MRI, when to order?
This weekend we attended a continuing education course put on by Sanford Spine, their 5th such class dedicated to doctors of chiropractic. The speakers included two physiatrists, a PhD researcher, and a neurosurgeon. One of the topics was back pain and included discussion on MRI and treatments. What was interesting is that much of what we discussed is what we see here on a daily basis. For example, we have many patients with back pain and leg pain that will come in and due to their discomfort; they are wondering if they shouldn’t “get an MRI to see what it is”. We hear this statement all the time, and the research surrounding MRI’s and back pain is very clear. It typically is NOT going to be necessary in the first several weeks of treatment. In fact, there are many studies that indicate that even GETTING an MRI on your back makes you WORSE. Why is that? Researchers, and many of the speakers this weekend and my colleagues in the room, think this happens because what is called “Pain expectation”. People think “Oh, I have a bad disc, I SHOULD be in lots of pain”. The mind is powerful, think how many times you’ve told yourself “Everyone around me has a cold, great I’m getting it”…and BAM, a day later you’re laying in bed with a running nose feeling like you’re head weighs 20 pounds, slightly whizzed at your friend for bringing 'their' cold to you. :)
Here are some stats from the course, these are from some of the most respected spine journals/studies available:
- Approximately 80-90% of the population will have back pain in their lifetime
- 50% of MRI’s taken will show ‘abnormal’ findings which often are NOT causing a problem and are NOT related to the patient’s symptoms.
- Typical back pain without pain referring to the legs will completely resolve by itself without any treatment in 90% of cases within 5-6 weeks.
So why do people get treated?
#1 Who wants to deal with back pain for over a month, or even a week?!!
#2 Approximately 72% of patients with back pain will have it return at some point (years later, months later...sometime weeks or days later) and who wants to go through another month of pain when the fix is often a few visits?!!)
So the bottom line here is that with getting a good history and exam from our patients we can identify any high risk patients where we should get imaging like X-Ray or MRI sooner than later, but the statistics are clear (and this is what we’ve seen in our practice), most patients do not benefit from getting imaging early in their care. We always consider this with our patients because these tests are expensive and as the research indicates, it probably won’t change our treatment plan anyway AND as noted above, the patient often gets worse just because they had the test.
Another researcher spoke of concussions and youth football, a pretty hot topic these days…more on that at a different time.