Just kidding…but not really. If I had a nickel for every time I’ve had to talk a patient off the ledge after seeing his or her imaging report, I’d be a rich woman. The story often goes a little like this. Bob, a 54 year old HVAC repairman, comes in to see me because he hurt his shoulder or foot or whatever and the first thing I notice is that Bob clearly also has pain in his back. When I ask him about it, he says that it has been hurt for a while. Once or twice a year, his back “goes out” and he’s laid up for a few days but there’s nothing he can do about it because he has some bad discs. You see, Bob went to his family doc a couple years ago to get his back checked out. The family doc sent him for an MRI and the MRI showed, you guessed it, degenerative disc disease at L4-L5, disc bulges at multiple levels, perhaps a herniation or two, and maybe some foraminal or central canal stenosis. Although Bob is pretty depressed about the state of his spine, he finds some comfort in the fact that at least he knows why his back has been giving him trouble for years. And here’s where my job gets tricky, I have to tell Bob that there’s a pretty good chance that he’s wrong.
You see, Bob has become a Victim Of Medical Imaging Technology (thanks APTEI for the witty, yet disgusting, acronym that I have chosen to omit). While MRIs can be invaluable tools when you need to rule out red flags or when frank nerve root compression signs are present, for the most part, they tend to do more harm than good. Why, you may ask? Two reasons:
Reason #1 - What’s on your MRI report often has NOTHING to do with your pain
According to a recent study by Brinjikji et al, “signs of degeneration are present in very high percentages of healthy people with no problem at all. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”1 The chart below indicates the prevalence of MRI findings in people with NO BACK PAIN.1 It shows that if we MRI’ed 10 pain-free 54 year olds, 8 of them would have disc degeneration findings and 6 would have disc bulges just like Bob but he has 7/10 pain and the others have none. How is that possible? Likely because Bob’s MRI findings aren’t what is causing his pain. Don’t get me wrong, there are certainly times where a degenerative disc issue could be the culprit but in the vast majority of cases, disc degeneration is just a normal part of aging, like wrinkles on the spine.2
Reason #2 - People who know what’s on their MRI report tend to feel WORSE
Seriously, MRIs for low back pain can sometimes do more harm than good! Several studies have shown that patient knowledge of imaging findings leads to more doctor’s visits, longer lasting pain, more disability, and a lesser sense of well-being.3,4 This is likely because many patients interpret their imaging findings to mean that the back needs to be protected, resulting in unnecessary fear avoidance of movement and activity.5 This type of avoidance can actually make the back pain worse. This certainly lends credence to the idea that ignorance is bliss, at least when it comes to your spine.
So what’s the bottom line? You are NOT your MRI findings. Get evaluated by a competent practitioner (like one of the fabulous docs at Nelson Chiropractic and Pilates) who can help you figure out what’s really causing your pain. And when you’re ready to burn that MRI report, give me a call…I’ll provide the matches.
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6.
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015 Sep.
- Ash LM, Modic MT, Obuchowski NA, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008 Jun;29(6): 1098-103.
- Modic MT, Obuchowski NA, Ross JS, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiology. 2005 Nov;237(2):597-604.
- Darlow B, Dowell A, Baxter GD, et al. The enduring impact of what clinicians say to people with low back pain. Ann Fam Med 2013;527-34.
Dr. Kelli Velez