Or learn when to worry about back (and when not to). Got low back pain? See the advanced low back pain tutorial. Wise use of MRI is great, but the common overuse and abuse of MRI is a disaster of over-medicalization. MRI also isn’t even completely safe-injected contrast agents can cause severe allegric reactions, sometimes lethal. 4 Premature MRI is actually often worse than useless, scaring patients badly and doing real harm. But low back pain experts have long understood that you simply cannot reliably diagnose low back pain with MRI or with X-ray in isolation 3 - and trying to do so reliably raises false alarms that actually do harm. Radiology reports are usually written without clinical context, and results are often presented as if a spinal glitch is a diagnosis in itself. Zooming in on what MRIs show is doomed to diagnostic failure. Low back pain (like most chronic pain) is extremely multifactorial, and the spinal glitches MRI reveals are just one ingredient in a rich stew of risk factors. Diagnosis based mainly on such findings is usually misleading. Spines usually look worse than they are! Seemingly scary spinal degeneration is shown by MRI in high percentages of asymptomatic people. 1 2 MRI can shine when it’s actually needed and done well.īut if MRI is a great power, it’s not being used with great responsibility: it’s not needed anywhere near as much as it is actually used, and it’s especially not needed for most low back pain. MRI especially is a miracle technology, no doubt about it - the ability to get clear images of soft tissues deep inside the body is valuable, and extremely tempting for everyone involved. They don’t always make false alarms, of course. When it comes to diagnosing most back pain, MRI machines are like Monty Python’s medical machinery that goes “bing.” For back pain, MRI and X-ray are medical machines that make false alarms. Patients should politely refuse early MRI and privately resolve to take radiology reports with a huge grain of salt. So how should imaging be used? Minimally! Only when it’s strongly indicated by persistent major symptoms, and interpreting results only in clinical context. There are also huge quality control problems with MRI, just shoddy work, like bizarrely conflicting results for the same patient from ten different MRI facilities - laughable if it weren’t so tragic. Zooming in it is not only doomed to diagnostic failure, but it can spook people and do real harm, because nothing is more clearly worse for back pain than anxiety. Seemingly serious spinal degeneration is found in high percentages of asymptomatic people. But spines usually look worse than they are. Imaging makes it easy to focus on what seems important: the spine. Zooming in on what MRIs can show is doomed to diagnostic failure, a classic “streetlight effect” mistake: focusing only where the light is good. Low back pain (like most chronic pain) is extremely multifactorial, and the spinal glitches that imaging reveals are just one ingredient in a rich stew of risk factors. Wise use of imaging is a superpower, especially MRI, but it’s often used irresponsibly overuse and abuse of the technologies is an over-medicalization disaster, criticized for since at least as far back as the 1990s. Results are often so misleading that they are worse than useless out of clinical context. When it comes to diagnosing low back pain, MRI and X-Ray are egregious false alarm generators.
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