Why imaging may not be the most helpful in understanding your pain

“ As soon as I get my MRI then I’ll really know whats going on.”  

“ I’m going to have back pain. My x ray showed arthritis and the MRI said I have a bulging disc.”

We have been conditioned to believe that seeing is believing and in the medical world, never have we been more able to “see” every part of our insides with amazing digital clarity. It would follow then that we would be better able to diagnose and treat our maladies, right? Well, not so fast. 

A recent article in the Journal of the American Medical Association has highlighted the growing body of research that says we are imaging WAY TO MUCH ! There is actually some evidence that with simple, common lower back pain imaging can serve to make you worse!

“In 2016, 118 out of every 1,000 Americans got an MRI. The use of CT scans was even higher: 245 per 1,000 people in 2016”

How is that possible!?  Well, there are a few reasons. We have learned over time that as we age we ALL develop what are termed “normal age-related degenerative changes.” A new baby has nice shiny smooth joints, however if you have spent even a couple decades working against gravity you will show some wear and tear. It happens to all of us to some degree and research has shown us that even if you take a large group of people with no pain and no history of pain and you put them all through an MRI scan, you will find A LOT of “abnormalities, degeneration and even the dreaded “bulging disc”!  Research shows us that there are people with no pain and no history of pain that, when given an MRI, demonstrate horrible degenerative changes and disc bulges. On the contrary many people with longstanding chronic pain have spotless MRIs. 

In the absence of a trauma or injury , with nonspecific general low back pain there is rarely a need for advanced imaging, and too much information can lead to making poor decisions in care – treating a picture and not the true source of the pain.  As physicians from the Mayo Clinic and Stanford University, in the viewpoint article in JAMA argue ,  it’s time to put the brakes on unnecessary and wasted diagnostic imaging.

If you are in a situation where you are concerned about your symptoms and wondering if advanced imaging is appropriate, or have any questions about this topic please reach out and talk to us. We would be happy to help you understand this recent report. Sometimes imaging is a definite need, sometimes it is of very limited help, or even harmful. Educate yourself …. Knowledge is power. 

Choose Change. Choose Delta. 

—— Read the article on the JAMA website

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