The MRI caused patient pain

If you want to be a good doctor – think twice about ordering an MRI for acute back pain. Here is what researchers at the  University of Connecticut Health Center said in reviewing published data:

The risks associated with early imaging for low back pain, includes:

1. patient “labeling,”
2. unneeded follow-up tests for incidental findings,
3. irradiation exposure,
4. unnecessary surgery,
5. and significant cost.

They suggest that routine imaging should not be pursued in acute low back pain as avoiding MRI use in aculte low back pain patients will reduce risks and costs without affecting clinical outcomes.1

Is immediate imaging important in managing low back pain

“Available evidence indicates that immediate, routine lumbar spine imaging (MRI or CT) in patients with lower back pain and without features indicating a serious underlying condition did not improve outcomes compared with usual clinical care without immediate imaging.

Clinical care without immediate imaging seems to result in no increased odds of failure in identifying serious underlying conditions in patients without risk factors for these conditions.

In addition to lacking clinical benefit, routine lumbar imaging is associated with radiation exposure (radiography and CT) and increased direct expenses for patients and may lead to unnecessary procedures.

This evidence confirms that clinicians should refrain from routine, immediate lumbar imaging in primary care patients with nonspecific, acute or subacute LBP and no indications of underlying serious conditions. Specific consideration of patient expectations about the value of imaging was not addressed here; however, this aspect must be considered to avoid unnecessary imaging while also meeting patient expectations and increasing patient satisfaction.”(2)

The MRI caused patient pain

“Degenerative disc disease is associated with low back pain, although the strength of the association varies with the definition. In a study of patients with back pain who underwent MR imaging and were then randomized to (1) disclosure of MR imaging findings to the patient and physician or (2) withholding of the findings, patients who were told that the MR imaging showed benign degenerative disc disease had a diminished sense of well-being compared with patients who were not told their MR imaging results…In another study, patients who underwent lumbar radiography for back pain of at least 6 weeks’ duration reported more pain and worse overall health status after 3 months than those who did not undergo radiography. The patients who underwent imaging also were more likely to seek follow-up care.

The performance of MR imaging for acute low back pain may be associated with deleterious outcomes. In a randomized controlled trial comparing MR imaging with standard lumbar radiography for low back pain, patients in the MR imaging arm of the trial were more than twice as likely to undergo surgical interventions than patients in the lumbar radiography arm.

For work-related acute low back pain, another study found that patients who underwent MR imaging within the first month had more than an 8-fold increased risk for surgery and more than a 5-fold increase in subsequent total medical costs compared with matched control patients who did not undergo early MR imaging. Regions with higher use of advanced imaging for low back pain also have an increased rate of spinal surgical procedures for low back pain; greater use of imaging is not associated with better patient outcomes.”

At the Magaziner Center for Wellness, we rarely if ever rely on an MRI. In our opinion these tests are a waste of money. A patient can come in with a big file of films and scans that cost them a lot of money out-of-pocket, and typically, there will be no useful information that will help us get the athlete back on the field. A skilled physician can make a more accurate determination of an athlete’s injury and treatment plan with a careful physical examination and history.

Unfortunately, there is a certain appeal to the patient to get an MRI, especially the athlete who thinks it is part of the normal process of treatment. It is sometimes difficult to get the patient to understand that when they get an MRI there will be a recommendation for a surgery that many times is unnecessary.

Unnecessary surgery based on MRI

“MRI alone may provide insufficient or inaccurate information upon which to base surgical/technical decisions in about of 30% of cases (of back pain).”(3)

British Doctors and specialists at Southampton General Hospital in England noted in their own research that their own professionals could not agree on what the MRI said in diagnosising lumbar disc disease.

“we found in our study that there is wide variation in diagnosing lumbar disc disease between the Orthopaedic Surgeons and the Radiologists at our institution…Due to this amount of inaccuracy, it is risky to comment on degenerate disc disease on a plain radiograph alone. Therefore MRI scan should only be used to comment on the disc diseases of the low back, as plain radiographs are unreliable.” (4)

Before you consider the surgical option based on an MRI a consultation with a doctor trained in non-surgical treatment of ligament and tendon injuries, such as Prolotherapy and PRP (Platelet Rich Plasma) Therapy, may be an option to surgery.

1. Srinivas SV, Deyo RA, Berger ZD Application of “Less Is More” to Low Back Pain. Arch Intern Med. 2012;172(11):1-5. doi:10.1001/archinternmed.2012.18382.
2. Is immediate imaging important in managing low back pain? J Athl Train. 2011 Jan-Feb;46(1):99-102.