Is an MRI Necessary for My Back Pain?

Low back pain is one of the most common medical conditions that people will face. In fact the World Health Organization estimates 60-70% of individuals in industrialized countries will have at least one bout of back pain in their lifetime.[1]

Despite its prevalence, the exact cause of low back pain can be difficult to diagnose with a great degree of accuracy. Many structures can cause back pain and teasing out specific structures and causes can be challenging. As a result, many people feel they should have an MRI to identify the source of back pain. This, however, is often not the most prudent decision. 

Why is getting imaging for low back pain not always the best decision? A few reasons: 

1. Studies show it does NOT result in better long term outcomes: Routine radiology tests (x-ray, CT, MRI) have no benefit for musculoskeletal low back pain. Six good studies that compared routine radiology tests with no testing for patients with musculoskeletal low back pain showed that patients did about the same regardless of whether they got the tests. Some studies even suggested that patients did better without routine testing.[2]
2. Testing often reveals normal findings that have minimal clinical relevance: One study published in the American Journal of Neuroradiology reports that 68% of asymptomatic patients (those without pain or symptoms) in their 40s will show disc degeneration on an MRI. The same study showed 80% of individuals in their 50s will show disc degeneration.[3] What does this all mean? It is normal to find signs of “wear and tear” in an MRI of your low back. The important thing is correlating these findings with clinical presentation in order to guide treatment. 
3. Early imaging often leads to patient fear. This goes hand in hand with reason 2. The findings that will inevitably show up on a low back MRI often cause patients to become apprehensive about movement, activity, or their ability to get better. Any practicing clinician can tell you about a patient with a relatively small, normal finding on an MRI that becomes “stuck” in the patient’s head and delays their progress and ability to improve. 
4. Increased Cost: One study found that for work-related acute low back pain, having an MRI within the first month resulted in patients being eight times more likely to have surgery and total medical costs were more than five times higher for patients compared to those who did not an early MRI.[4] No one likes paying out-of-pocket costs for services such as physical therapy, but in the end, the cost is often much less than the MRI, let alone any subsequent testing or treatment. 

There can be times when MRI for low back pain can be totally warranted. These times include, but are not limited to: a history of cancer, progressive weakness in legs, abnormal reflexes, following trauma, and if changes in bowel or bladder function are observed. 

Aside from these relatively rare situations, starting with conservative treatment including physical therapy is often the best path to help reduce back pain and get back to normal function.

The highly educated, skilled therapists at Agape are ready to help you get back to feeling your best and living the life you want. 

References

1. World Health Organization (2013) Low Back Pain

2. Annals of Internal Medicine (2011) Radiology Tests for Patients With Low Back Pain: High-Value Health Care Advice From the American College of Physicians 

3. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations 

W. Brinjikji, P.H. Luetmer, B. Comstock, B.W. Bresnahan, L.E. Chen, R.A. Deyo, S. Halabi, J.A. Turner, A.L. Avins, K. James, J.T. Wald, D.F. Kallmes, J.G. Jarvik 

American Journal of Neuroradiology Apr 2015, 36 (4) 811-816; DOI: 10.3174/ajnr.A4173 

4. Webster BS, Cifuentes M. Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. J Occup Environ Med. 2010;52(9):900-907. doi:10.1097/JOM.0b013e3181ef7e53