Can MRIs Reveal Back Pain?

The prospect of undergoing an MRI scan can be extremely daunting. In addition to the fact that a scan could mean that there may actually be something amiss in your body, the thought of lying alone in a noisy, confined space is a frightening prospect for many. Like many medical contraptions, an MRI is something most of us will endure for the sake of achieving a correct diagnosis. But are they really useful in diagnosing the majority of lower back conditions?

What’s interesting in using MRI scanners as a diagnostic tool for lower back pain is what they reveal can be misleading to the patient. For example, MRIs commonly show abnormalities in the spine that have no link to the patients’ symptoms whatsoever. Wear and tear, disc degeneration and arthritis often come with the increasing age of the hardworking spine, but is that information particularly helpful to a patient whose back pain has nothing to do with these factors? For many anxious patients, these common ‘abnormalities’ may only cause additional and unnecessary worry; a ‘false alarm’ in the search to discover the true cause of their symptoms.

Many leading chiropractors claim that about a third of middle aged people with no back problems would have abnormal MRI results. On the flip side, many back pain patients who suffer with extreme pain have normal MRIs. Pain is not black and white; we cannot take a picture of true pain, even with medical advances as impressive as they are today.

There is no disputing that MRI is an incredible technology. The capability of achieving clear pictures of soft tissues within the depths of the body is extremely valuable for diagnosing many medical complaints and MRI scans have saved and continue to save lives every day across the world. But diagnosing the cause of most types of lower back pain isn’t best placed with MRI scanning, so it seems. Of course, there are always exceptions and sometimes MRI scans do discover underlying reasons for lower back pain. However, looking towards MRI machines for a general answer of why a patient suffers from back pain shouldn’t always be the primary route of investigation.

This argument was recently put to the test in a study where researchers attempted to diagnose back pain using only MRI results, with no prior medical information about the patient. The study involved patients with stenosis (narrowing of the spinal canal) based on the thinking that stenosis always presents with pain. Interestingly, the study revealed that few patients with the associated kind of pain had narrowed spinal canals! Similarly, those who did have narrowed canals did not report that they were experiencing any pain. In this study, the researchers could not accurately diagnose lower back pain using MRI alone.*

For the majority of people with any kind of medical condition, the word “scan” strongly implies that there’s a possibility that something could be seriously wrong – which is a common fear in those suffering from chronic back pain. Taking into account the many unrelated spinal abnormalities that MRI scans reveal, is it worth adding to this fear with a scan that may not help with diagnosis and may just identify unrelated abnormalities?

The lack of clarification that many results give also brings an element of confusion to the patient. Many people who present without pain have all kinds of “abnormalities” with their backs and many people with pain have normal scan results. This potentially creates a risk of diagnoses and treatment running in all sorts of directions.

MRI scanners are useful for detecting the cause of certain types of lower back pain, but the requirement should be evaluated by each patient’s individual case.

* Haig AJ, Tong HC, Yamakawa KS, et al. Spinal stenosis, back pain, or no symptoms at all? A masked study comparing radiologic and electrodiagnostic diagnoses to the clinical impression.

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