3 Reasons Why Getting An MRI For Your Neck or Back Pain Might Be A Bad Idea
Neck and back pain are both very common. According to the World Health Organization, about 80% of people will experience low back pain at some point in their lives, while approximately 50% of people will experience neck pain. Many people who experience spinal pain want to know the exact cause of their pain and think that advanced imaging will provide the best information regarding the cause. For spinal pain, this usually means a Magnetic Resonance Imaging (MRI). However, that isn’t the case. Here are THREE reasons why getting an MRI for your neck or back pain is a bad idea.
- MRI findings are generally worthless
Surprised? Don’t be. I’m sure some of you reading this probably have had an MRI on your neck or back. Maybe it showed a disc bulge, or disc protrusion, or degeneration, or spondylolisthesis, or some other cause of your pain. Unfortunately, these findings are usually not the main cause of your pain. How do we know this? Because all those findings are extremely common in pain-free individuals.
A recent review[i] looked at 33 studies consisting of a total of 3,110 asymptomatic people. Asymptomatic means these individuals had no neck pain, no mid back pain, and no low back pain. And they had no history of back pain either. So they can’t have any degeneration or disc injuries right? WRONG. Disc degeneration was found in 37% of 20-year-olds and increased up to 96% in 80-year olds. Disk bulges were present in 30% of 20-somethings and increased up to 84% in those octogenarians. Disc protrusions? Present in 29% of 20-year olds and up to 43% in the 80-year olds. Another study[ii] found no association between “spondylolysis, isthmic spondylolisthesis, or degenerative spondylolisthesis, and the occurrence of LBP”. So if you’re reading this article, I can almost guarantee that you have some kind of degeneration or disc injury in your spine. And research suggests that it has no correlation with whether or not you have any pain. We call these findings “false positives.” Think of them as false alarms.
A disc protrusion. ~30-40% of pain-free individuals have these!
So does imaging ever show the actual cause of pain? Yes. These cases include moderate-severe central stenosis, nerve root compression, and disc extrusions. All of which are pretty uncommon. Luckily, all of these can easily be identified by a thorough examination alone and can often be improved with conservative therapy. Other causes of pain that can be identified with MRI are more serious causes such as infection or cancer. Again, a thorough history and clinical examination will usually discover these issues.
- It can lead to worse outcomes
This one might be even more surprising. One large study[iii] looked at 3,264 workers compensation cases with low back pain and compared the outcomes of patients who received an MRI vs. those who did not receive an MRI. Now, you might realize that those getting an MRI will often (but not always) coincide with more serious low back pain and thus, worse outcomes. The uber-intelligent researchers realized this and split the patients into two groups: those with “high propensity for MRI” (more serious cases) and those with “low propensity for MRI” (less serious cases). They then analyzed the effect of having an MRI vs. not having an MRI in each group and compared the outcomes. So what did they find?
Patients that received an MRI had an average of 482% MORE days on disability! And even worse, patients that did not have an MRI had surgery less than 10% of the time, while those that received an MRI had surgery 80-100% of the time! These are obviously very large differences. And according to the research, those differences were due to nothing else but getting an MRI.
How can getting MORE information lead to a WORSE outcome? It is due to all those false positive findings mentioned above. If you have low back pain and then get an MRI, and then have a very intelligent and well-meaning doctor point out a possibly random finding as the cause of your low back pain, this has a GIANT social and psychological impact. If you truly believe that your low back pain is caused by a disc herniation that can only be fixed by surgery, all other treatment options will fail.
- It’s expensive
MRIs aren’t cheap. They also lead to worse outcomes as mentioned above, which means more exams, visits, and various procedures. All of which costs even more money. One study[iv] found that in even the most minimal low back pain cases, getting an MRI lead to approximately $8,000 higher medical costs. For more serious cases, medical costs were about $14,000 higher compared to those who did not receive an MRI. Use your money wisely!
In summary, if you want some generally pointless imaging results, more disability, longer lasting pain and have thousands of dollars burning a hole in your pocket, get an MRI. If you want to get your pain better, visit our clinic or an evidence-based practitioner near you.
Jeff Remsburg DC MS DACRB Cert MDT
[i] AJNR Am J Neuroradiol. 2015 Apr; 36(4): 811–816.
[ii] Spine (Phila Pa 1976). 2009 Jan 15;34(2):199-205
[iii] J Occup Environ Med. 2010 Sep;52(9):900-7
[iv] Spine (Phila Pa 1976). 2013 Oct 15; 38(22): 1939–1946