Early MRI for Work-Related Low Back Pain is Associated with Increased Disability and Higher Medical Costs
Monday, October 11, 2010 at 10:11PMMagnetic Resonance Imaging (MRI) is a powerful tool for the treatment and evaluation of low back pain. However, interpretation of results can be a complicated undertaking.
Studies have demonstrated that “disc herniations” are found in approximately 30% of asymptomatic patients.[i] What is more, there is limited (or no) evidence to suggest that some MRI abnormalities (e.g. annular tear, herniated discs, or end plate fractures) developed as the result of an acute traumatic injury.[ii]
There are practice guidelines established for the use of MRI in the management of acute low back pain. Usually, an MRI is recommended within the first 4 weeks of symptoms only if “red flag” conditions are suspected (e.g. cauda equina syndrome, fracture, tumor, infection, or serious nonspinal conditions).[iii] Despite these recommendations, MRIs are often ordered early on in the course of acute low back pain without a clear indication.
A recent study highlights the fallout that can come from early ordering of an MRI in the context of acute work-related low back pain. [iv] Webster et al. looked at a series of 3,264 cases. They found that 21% had early MRI ordered and, on average, the early MRI was taken within the first 2 weeks after onset. [v]
The authors found that cases “that had an early MRI were more likely to have prolonged disability, higher medical costs and greater utilization of surgery.” [vi] The authors reported that a full 22% of those that had an early MRI went on to have surgery and also were more likely to receive early opiate prescriptions, even after adjusting for severity. [vii]
This study, in line with related studies, demonstrates an iatrogenic ill effect associated with obtaining early MRI studies. Evidence suggests that patients or clinicians or both misinterpret the presence of abnormalities to be indicative of a “more specific and severe diagnosis.” [viii]
So, ignorance is bliss. Or maybe “abnormalities” on an MRI are not necessarily that “abnormal.” Maybe that little disc bulge noted on an MRI has been there for years and is unrelated to current pain symptoms. Maybe we should all just be better at following guidelines.
[i] J Bone Surg Am. 1990; 72: 403-408
[ii] Spine. 2000; 25: 1482-1492
[iii] J Occup Environ Med. 2010; 52(9):900-7.
[iv] J Occup Environ Med. 2010; 52(9):900-7.
[v] J Occup Environ Med. 2010; 52(9):900-7.
[vi] J Occup Environ Med. 2010; 52(9):900-7.
[vii] J Occup Environ Med. 2010; 52(9):900-7.
[viii] J Occup Environ Med. 2010; 52(9):900-7.
Reader Comments (2)
It is so refreshing to see a study like this! I have found in my practice that most patients hang on every word that is printed in that MRI report. And most of the time the MRI finds something wrong. This only serves to reinforce the "I am damaged goods" mindset of the patient and does much more harm than good. I often tell patients straight up that 30% of the time in normal individuals with no pain there will be abnormal MRI findings. I try to downplay the MRI findings as much as I can as long as the symptoms they are experiencing aren't red flags and do not directly correlate with MRI findings. I look at the MRI as a "necessary evil" more often than I look to it as anything beneficial in most patients. And one more thing. Ways to cut health care costs? How about we stop doing so many MRI's!! Unless patients have red flag symptoms it is completely unnecessary!
I agree wholeheartedly. People hear words like degenerative disc disease from an MRI report and jump to the conclusion that back pain is necessarily a progressive condition. People since the dawn of time have had backaches and generally get better and are able to function.