DO YOU REALLY NEED THAT X-RAY OR MRI FOR YOUR BACK PAIN?

It’s time to bust some back pain myths!

If you didn’t catch John’s last blog post about what you should do when you have lower back pain, check it out here!

I’m writing this to change your thinking a little bit.

So, the ultimate question.

Do you need an X-ray or an MRI when you have back pain or sciatica-type symptoms?

Believe it or not, research says…. drumroll, please….

NOT ALWAYS!

Lower back pain is the leading cause of global disability. For years, physicians have prescribed diagnostic imaging as a first line of defense for treating back pain. Yet, if we look at what research says, this may be detrimental to your pocket and the healing process. In fact, the prescription of imaging for non-specific low back pain correlates to negative patient labeling and persistent pain. It also has been shown to increase medical costs, healthcare utilization, and time off from work. 

Let’s just throw this out there. Say you are a scientist looking into the correlation of findings on lumbar imaging and patient pain. What would your hypothesis be? If I had to guess…

“Findings on lumbar imaging directly correlate to pain…” or something along those lines.

Well, what if I told you that your hypothesis is actually incorrect.

In 2015 there was a systematic review done by Brijinski et al. that investigated the findings of lumbar imaging in asymptomatic individuals. Yes, that means these individuals did not have any pain.

What this review found:

“Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age.”

So, basically…..

No matter how old you are, it is common that there be some sort of degenerative abnormality on diagnostic imaging of your lumbar spine.  So, if you were to have an MRI or X-ray, more than likely there would be some sort of negative finding that pops up, even without pain!

In 2007, the American College of Physicians and the American Pain Society released practice guidelines addressing the use of diagnostic imaging for lower back pain.

In summary, these are the proposed recommendations: 

1. Imaging is not required in patients with nonspecific lower back pain unless red flags are suspected.
2. Imaging should be ordered if there is evidence or suspicion of:

•  Severe or progressive neurological deficits (cauda equina syndrome, saddle paresthesia, absent deep tendon reflexes, significant weakness or sensory changes, bowel or bladder dysfunction).

*I would like you to note that they stated “severe or progressive neurological deficits”. For slight numbness or tingling in one’s leg, imaging is not always warranted!*

• History of or possible cancer diagnosis
• Systemic infection (Fever > 102)
• Prolonged use of corticosteroids
• Known trauma or fall

3. If lower back pain persists after conservative management (physical therapy, massage, acupuncture, chiropractic, etc.), imaging such as an MRI or CT scan should be performed ONLY if the individual is a candidate for surgery or epidural injection.

When addressing lower back pain, it’s not simply a biological ailment. Discs and degeneration do not always cause discomfort. What we must remember is that just because something may correlate to an individual’s discomfort, it does not necessarily mean that it is the cause of the discomfort. Instead of normalizing and continuing to diagnose lower back pain based on a biomedical model, the focus should be shifted to a biopsychosocial approach. Instead of just looking at an image, we truly must look at YOU, the individual, as a multi-faceted human. Why? Things such as lack of sleep, stress, depression, poor diet, and many other lifestyle factors are correlated to pain.

As a whole, we need to stop thinking about certain back ailments as “diseases” and normalize them as part of the aging process. Therefore, do you really think you need that X-Ray or MRI for your generalized lower back pain?

Also, to note, in most cases, generalized and non-specific lower back pain will subside in 6-8 weeks without intervention! 

Happy Healing!

Dr. Ashley