SaveYourself.ca • Sensible advice for aches, pains & injuries
published 10/08/07
Got low back pain? You should also visit the advanced low back pain tutorial.
I don’t know if magnetic resonance imaging (MRI) equipment goes “bing,” as in the classic Monty Python sketch — but, when it comes to diagnosing back pain, they are certainly almost as useless as Monty Python’s medical machinery.
MRI is a miracle technology, no doubt about it — the ability to get clear images of soft tissues deep inside the body is incredibly valuable. But not for most low back pain! Low back pain experts have long understood that you simply cannot reliably diagnose low back pain either with MRI, or with X-ray (see Deyo).
When it comes to diagnosing back pain, MRI is almost as useless as Monty Python’s medical machinery.And this important point has just been reasserted by the American College of Physicians and the American Pain Society in updated guidelines for the management of low back pain. Of course, the message has not yet reached many therapists and doctors, which is why it’s important that scientific journals are still publishing (and re-publishing) guidelines like these — eventually the message will get through!
Specifically, the recommendation was that doctors should avoid giving people X-rays and MRI unless the situation is dire (i.e. severe and persistent neurological symptoms). The authors of the guidelines labelled the recommendation as “strong,” and believe the evidence to support it is “moderate.” Actually, I disagree — I think that the recommendation should be “stronger than strong, very strong, really extremely strong,” and the evidence supporting it can be considered “bullet proof.”
So, why is it so important for doctors avoid X-ray and MRI? It’s a bad idea in two directions …
On the one hand, X-rays and MRIs scare people! It strongly reinforces the idea that something is broken or crooked, a common and extremely misguided idea about back pain. And nothing is worse for back pain than fear. Fear is the “little back killer” (that reference is for a few old science fiction fans).
On the other hand, X-rays MRIs often simply fail to clarify the situation, or even confuse it. A mountain of excellent scientific evidence clearly suggests that back pain correlates really, really badly with these test results. Many people with no pain have all kinds of things “wrong” with their backs, and vice versa.
Yes, there are exceptions, and that’s why these tests are appropriate for severe and persistent low back pain. But it’s just a generally lousy way to try to figure out why your back hurts. Consider the spectacular results of a study by Haig just last year, in which doctors using MRI could not accurately identify patients with stenotic (narrowed spinal canal) back pain, because so many patients with stenosis had never had any pain. That is the kind of doesn’t-add-up difficulty with MRI diagnosing.
Scientific evidence clearly suggests that back pain correlates really badly with these MRI findings.Yet it is still routine for me to see patients who have been X-rayed by their chiropractors and MRI-ed by their doctors in the early stages of back pain!
If you get back pain, and someone tries to beam rays through you prematurely, just say, “Thanks, but no thanks. The American Pain Society says it isn’t necessary unless I can’t feel my legs.”
Have you got chronic back pain? Visit my advanced patient tutorial, Save Yourself from Low Back Pain! Or for an interesting philosophical discussion of the general problem, see my new article, Your Back Is Not “Out” and Your Leg Length is Fine.
There are thousands of low back pain books — what’s special about this one? The problem is that 90% of doctors and therapists assume that back pain is structural, in spite of mountains of scientific evidence showing … exactly the opposite. Only a few medical experts understand this, and fewer still are writing for patients and therapists. Supported by 253 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of SaveYourself.ca’s trigger point tutorial! Add it to your shopping cart now ($19.95) or read the first few sections for free!
I also stumbled across a great article while writing this: “Technology Idolatory: An Exploration of Healthcare's Love Affair with Machines That Go "Bing"”.
