Many patients ask their doctors to use magnetic resonance imaging (MRI) to diagnose their chronic low back pain. They want to use the most up-to-date technology to determine the cause of their pain and to make sure it is nothing serious. But is MRI helpful? Does it provide benefit or simply expose the patient to risks?
Research studies confirm that MRIs are not necessary for most patients with low back pain and have generally been overused. Recently, an international medical team conducted a scientific review of research investigating MRIs and low back degeneration. Based on their assessment, the team reached the following conclusions: 1) There is insufficient evidence to support the routine use of MRI in patients with chronic low back pain; 2) Never use MRI findings alone to determine a surgical approach.
A concern for all low back pain patients should be false-positive findings. These are findings of clinically irrelevant abnormalities on the MRI that lead to unnecessary treatment. A recent study funded by the National Institute on Aging and National Institutes of Health examined the relationship between adults with and without chronic low back pain and degenerative disc and osteoarthritic disease. This study was conducted by researchers from the University of Delaware and University of Pittsburgh, and over 300 adults participated. This high quality study confirmed that degenerative disc and osteoarthritic disease is widespread in older adults, regardless of clinical status, with greater than 90% of patients demonstrating some level of degeneration. This study also demonstrated that the severity of disc and joint disease shown on MRI is not associated with pain severity in patients with chronic low back pain.
This study is supported by previous findings showing that disc degeneration is frequent among subjects without symptoms and is not clinically relevant. Degeneration of spinal discs is a progressive and normal age-related circumstance in adults, and it has only a weak relationship to pain and disability. Degeneration and herniation are biological realities, but pain and disability do not necessarily occur. Many imaging findings that traditionally were presumed to be pathologic are common in asymptomatic populations.
Researchers have also found that MRI abnormalities are not major predictors of outcomes in patients with low back pain. In fact, the joint guidelines of the American College of Physicians and the American Pain Society explicitly recommend not using routine imaging in patients with non-specific low back pain. Research also suggests that patients with whiplash injuries, spinal stenosis and meniscal tears might also want to avoid the routine use of MRIs.
The advice for patients is to avoid MRIs unless there is a compelling reason for their use. Talk openly with your doctor about your specific condition and possible alternative diagnostic methods. A complete medical history and physical examination can usually identify any dangerous conditions that may be associated with back pain, and simple blood tests are usually more accurate at locating early signs of serious medical issues.
(Dr. Tom Honka is a chiropractor specializing in the nonsurgical treatment of spinal conditions. His clinic is located in Porterville. Call 781-2222 for more information.)