Magnetic resonance imaging is an astonishingly successful technology which gives us great insights into the internal structure of the body, allowing accurate diagnosis and planning of treatment with a high degree of certainty. However, as recently flagged up in a BBC Health news article, MRI scanning can be positively harmful in the management of low back pain and should only be used if there is a suspicion of a serious underlying condition. Two groups were compared, one of which was scanned and one not, with results not differing over the short or longer term.
MRI scans are commonly requested perhaps because of patient expectations or because the referrer thinks it is a concrete thing to do and might show up the cause of the patient's back pain. Studies have shown that it is very rare for an MRI scan to shows up something important about a person's back problems but it is easier to do this than take the time to communicate the strategy clearly and answer the patient's many problems.
The incidence of MRI scanning as a choice for back pain investigation is increasing, perhaps because it is an easy thing to request. However it often raises more questions than it answers and leads to particularly difficult questions and misconceptions in patients' minds. Many of us explain the findings to patients using the wrong terminology. Our job partly is to reduce patient expectations about what scanning can achieve.
The examination and medical history of the patient should indicate whether there is a serious underlying cause for the back pain or whether it is mechanical. MRI scanning is not very useful in mechanical low back pain and should be reserved for cases where there are findings which indicate the necessity to do so and not just because the next step is not clear.
The underlying rationale for low back pain and the need or otherwise for imaging including MRI scanning should be part of patient education. The strategy should be laid out which includes a graded exercise programme, acupuncture and manual therapy course. A small proportion of back pain sufferers become chronically disabled and require a pain management programme to address their issues.
Explanations to patients are fraught with difficulties and many fall into what I call concepts without explanation, where the explanation is given to the patient with little or no care or checking as to what they take away from it. If we give them a concept to think about we have a responsibility to help them understand and fit it in to their attitudes and beliefs about their back pain in a realistic way. If we get this wrong by being careless with our communication this can have important and negative consequences.
Much of the explanation to patients comes under the category of what I call concepts without explanation. We give a concept, a way of seeing things, to patients but we don't give them the accompanying information they need to make sense of it and incorporate it helpfully into their view of their back pain and its management. This is a very bad idea and has very unhelpful consequences as the patient's interpretation of their condition informs their whole self-management.
Low back pain management is complicated and need time and good communication skills in the health professionals managing these types of condition and many other pain conditions. MRI scanning can be very useful in identifying disc prolapses, degenerate discs and infection or tumour. For mechanical low back pain it has a very limited role. - 16004
MRI scans are commonly requested perhaps because of patient expectations or because the referrer thinks it is a concrete thing to do and might show up the cause of the patient's back pain. Studies have shown that it is very rare for an MRI scan to shows up something important about a person's back problems but it is easier to do this than take the time to communicate the strategy clearly and answer the patient's many problems.
The incidence of MRI scanning as a choice for back pain investigation is increasing, perhaps because it is an easy thing to request. However it often raises more questions than it answers and leads to particularly difficult questions and misconceptions in patients' minds. Many of us explain the findings to patients using the wrong terminology. Our job partly is to reduce patient expectations about what scanning can achieve.
The examination and medical history of the patient should indicate whether there is a serious underlying cause for the back pain or whether it is mechanical. MRI scanning is not very useful in mechanical low back pain and should be reserved for cases where there are findings which indicate the necessity to do so and not just because the next step is not clear.
The underlying rationale for low back pain and the need or otherwise for imaging including MRI scanning should be part of patient education. The strategy should be laid out which includes a graded exercise programme, acupuncture and manual therapy course. A small proportion of back pain sufferers become chronically disabled and require a pain management programme to address their issues.
Explanations to patients are fraught with difficulties and many fall into what I call concepts without explanation, where the explanation is given to the patient with little or no care or checking as to what they take away from it. If we give them a concept to think about we have a responsibility to help them understand and fit it in to their attitudes and beliefs about their back pain in a realistic way. If we get this wrong by being careless with our communication this can have important and negative consequences.
Much of the explanation to patients comes under the category of what I call concepts without explanation. We give a concept, a way of seeing things, to patients but we don't give them the accompanying information they need to make sense of it and incorporate it helpfully into their view of their back pain and its management. This is a very bad idea and has very unhelpful consequences as the patient's interpretation of their condition informs their whole self-management.
Low back pain management is complicated and need time and good communication skills in the health professionals managing these types of condition and many other pain conditions. MRI scanning can be very useful in identifying disc prolapses, degenerate discs and infection or tumour. For mechanical low back pain it has a very limited role. - 16004
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Oxford or elsewhere in the UK.
