Do You Need an MRI for Your Back Pain?

When I am working with people who are dealing with an episode of back pain (with or without leg pain), one of the most frequent questions I receive is "Should I have an MRI?" In this article, I am going to discuss when an MRI is, and maybe more importantly, when it isn't needed. I will also discuss why having an MRI may not be a good thing in some situations.

Experiencing an episode of back and/or leg pain can be very painful and limiting-I know, I have had both! When it hurts and limits you so much, it is understandable to think that something serious is going on and you need to have an MRI to find out what is causing so much pain. In fact, your physician may also recommend that you have an MRI. Research shows that an MRI is used often to try and find out what is causing someone's back pain. The problem with this is, most times and MRI should not be done. Some of the reasons for this will be discussed below. Most of the information for this Blog comes from guidelines that were written by the American College of Physicians and published in the Annals of Internal Medicine. They were written to assist physicians in deciding when and MRI is needed and when it is not. 

First, when is an MRI indicated? If you are experiencing an new onset of back or leg pain and have noted a new onset of any of the following things, you should probably have an MRI:

• An inability to initiate urination or control your bowels
• Numbness in the area which would sit on a bicycle seat
• A new fever that came on with your back pain
• New onset of changes in balance
• Progressive weakness (you may notice you cannot hold your foot up, or you cannot go up on your toes)

In addition, if you have a history of cancer and experience a new onset of back pain, an MRI may be indicated.

The good news is that for the majority of back pain patients (around 90%), they have none of these. So, an MRI is usually not needed. You may be thinking "well, how will I know what is wrong then?" In the absence of those things listed above, we cannot know. In fact, 90% of back pain can be labeled "non-specific." This means that although there are a lot of structures in our back that have the potential to cause pain, we cannot identify which one actually is.  This may be hard for you to believe if you have had a previous MRI and been told that it is because of a certain problem- i.e. degenerative disc disease, bulging disc, arthritis, etc. So, let's discuss more about this.

When we look at some of these things found on an MRI of people having back pain, we see many of the same things in people without pain! In fact, degenerative disc disease, arthritis, bulging discs, etc likely become present in all of us as we get older. I wrote about this here:
www.promotiongb.com/blog/low-back-imaging-how-useful-is-it
​The same thing is found in neck pain:
www.promotiongb.com/blog/neck-pain-bulging-discs-and-degenerative-changes1135516
​So, we cannot really say then, that this is the cause of your pain-even though you may have been told it was! This is good news because it means you can get out of pain without having to change your spine structure-because we can't.
What about bulging and herniated discs? Well, bulging discs are very commonly present-even in people without pain. A herniated disc is more likely related to pain in the leg and can be an MRI finding that is important to note. Even then however, there is still hope for recovery without surgery. See below:
www.promotiongb.com/blog/july-15th-2019
and here:
www.promotiongb.com/blog/what-happens-to-herniated-discs
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So, what's the harm in having an MRI? Maybe just to rule out anything really bad? Well, there has been shown to be a lot of negative consequences to having an MRI when it is not needed. First, research has shown that people who have an MRI (particularly early-within the first 6 weeks of pain onset), do not recover as well. One explanation for this is that once someone has an MRI, they are labeled with a diagnosis (degenerative disc, bulging disc, etc) even though this may not be the cause of their symptoms. Being told you have a degenerating spine or some other "problem" can have a negative impact on your perception of your back and make it more difficult for you to recover. We cannot separate the body from the mind, and you cannot "unsee" your MRI. 

Secondly, in our health system today, once you are given a diagnosis, there is an intervention for that-again, even if it is an intervention for something not causing pain. More research has shown people who receive an MRI are more likely to be prescribed opiods, receive injections, and even have a surgery! These would not be bad if they helped most patients, but again research shows that long term outcomes are not any better with these interventions than more conservative care i.e. appropriate treatment. 

Lastly, MRIs are expensive to individuals, insurances, and our healthcare systems. If warranted, they absolutely can be beneficial. However, many MRIs are performed without following clinical guidelines on when to do them.

So, if you are having back and even back and leg pain, please contact me. With detailed questioning and a thorough examination, I will be able to tell you if you need an MRI. If you do not, most back pain episodes will get better  on their own and/or with some treatment and advice on what you can do to help get you out of your pain episode.

I hope this article helps and please reach out if you have questions.
Thanks for reading,
Bob







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Now, why is this important to understand and how does it relate to MRIs and your health?