MRI Overused for Back Pain
A study recently done by Canadian physicians reveals that the use of magnetic resonance Imaging (MRI) for low back pain is often done inappropriately. In Canada this poses an especially difficult problem as it adds to the already long wait time for the use of the MRI machine for those who really need it such as those with headache symptoms who need brain scans to determine a diagnosis.
Written by Derek J. Emery and colleagues for the March 25, 2013 issue of JAMA Internal Medicine, only 443 MRI scans out of 1,000 (44.3%) were deemed an appropriate use of that resource. MRI’s performed for headache patients fared much better, with 82.8% passing the criteria to be considered appropriate.
The authors state that family physicians were the most likely to inappropriately order MRI’s for back pain, as “only 39.9% of their MRI scans were considered appropriate vs. 58.1% of those ordered by other specialties.”
Those of us who treat low back pain every day, see this happen all too often. Patients are often told that they “have a bad disc” because the first step in another physician’s office was to order imaging as opposed to doing simple, well known orthopedic tests to determine the pain generator of the patient. It’s cheaper, and often gives better information than imaging.
The patients, of course, are the real losers in all of this. MRI’s aren’t cheap in the states. It is common knowledge that a great deal of the population is walking around with asymptomatic disc lesions, and therefore it is likely that there will be something to see on a scan. Often, seeing a bulging disc leads to treatment recommendations that are too aggressive from the doctor, and a psychological response that is too extreme from the patient. After all, we all know someone who had back surgery for a disc injury. It’s also not too uncommon to know someone who had a back surgery that didn’t go all that well.
The answer? Treat back pain with conservative methods for at least two weeks before moving to imaging. This would spare patients the expense of the imaging, and free up the machine for more pressing concerns like the afore-mentioned headache patients.