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Imaging Tests for Low Back Pain- Is It Necessary?

disc herniation on MRI

courtesy of wikipedia

It would seem that imaging tests, such as x rays, CT, or MRI, would be a great idea for severe low back pain. Wouldn’t having a picture of the painful area of your back reveal a back pain cause to be treated? Yet there are several reasons why imaging tests for low back pain may not be as helpful as it seems.

Imaging tests don’t accelerate your low back pain recovery.

The majority of people with new low back pain feel better after 4 weeks regardless of the imaging tests performed. One study of 1,800 cases of low back pain found that those who received an MRI soon after the pain started were no better in 4 weeks than those who did not. In fact, by following the best treatments for back pain, you can best speed your recovery. Imaging tests give the doctor information to help answer a question. Spine specialists understand that most cases of back pain are not structural problems, so a picture of the structure is not helpful for making treatment decisions.

Imaging tests can make you worse.

Surprisingly, one research study demonstrated how those with back pain who get an MRI within the first month of pain are 8 times more likely to have a spine surgery.  These patients also had 5 times the medical expenses, and, of course, didn’t recover faster than those who didn’t get an MRI.

These findings are likely because of false positives found on the imaging tests. Imaging tests often reveal spinal abnormalities that are completely unrelated to the pain. One large study found that 40% of individuals under 30 years of age have positive MRI findings of disc arthritis.  By 50 years of age, the prevalence of disc arthritis climbs to over 90%.  I often refer to this as “grey hair and wrinkles” on the inside of the spine. It is the normal, slow process of spine aging that often gets blamed for new low back pain. When imaging tests reveal these normal spine changes in your painful back, you are more likely to be viewed as a candidate for spine surgery than someone whose spine is treated without surgery or injected drugs. If most spine pain isn’t caused by spine abnormalities found on imaging tests, then it is low back movement dysfunction that causes most back pain. If you already have been told that you have low back arthritis, don’t worry about that “causing” new or episodic low back pain. If the arthritis is always there, while the pain comes and goes, then here must be a better explanation of your pain.

Yet, imaging tests may be crucial.

MRI imaging test for low back pain

MRI device

Tests help your doctor to answer questions. If you doctor has reason to expect a serious underlying problem such as cancer, infection, or serious/worsening nerve damage, then thorough imaging tests can direct you to the best treatments for these dangerous causes of back pain. Individuals with back pain need imaging tests to screen for these dangerous causes. Those who have a history of cancer, unexplained weight loss, fever, a recent infection, altered bowel or bladder control, abnormal neurological reflexes, clinical weakness in the arms or legs, or over 50 years of age may be candidates for imaging tests after a careful examination.

As a nerve, muscle, and joint pain specialists, I realize that people often get conflicting recommendations about how best to treat their back pain and if they need imaging tests like x-rays, a CT scan, or an MRI. It is my goal to partner with each patient, making sure they have the right information to make the most informed decisions about their health.

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine. 2007 Oct;147(7):478-491.

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  1. Do you need to have imaging on your back? - siskiyoupt.com - October 15, 2013

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