Beware the MRI

Last week a 34 year old patient came into the clinic with a 15 year history of low back pain.  The first thing he did was to lay a large folder containing his MRI images down on the table.  I did not look at them.

It's not to say that I was indifferent to his magnetic resonance imaging results.  Rather, I wanted to hear from him first.  I wanted to know about his history.  When did his pain start?  What does he do for a living?  When does his back bother him most?  Are there changes in his pain based on positional changes?  These a just a few of the many questions I'll ask a patient before I even bother to look at an imaging report.  And here's why:

Imaging can reveal tissue "damage" without associated painful dysfunction.  In other words, there is not necessarily a direct causative relationship between a positive MRI and pain.

This is a pretty powerful concept for patients to be educated about.  If a person believes that they have a "bad" back based on imaging that reveals a disc herniation or some other "defect" in their spine, then their mind can play crazy tricks on them.  It's called the nocebo (Latin for "I will harm") effect and is opposite the more commonly known placebo effect.  Just thinking that something is wrong may lead to disproportionate pain and dysfunction.

Here's what I always say to my patients who present to the clinic similar to the above referenced person:

"If you went out on the street an grabbed 100 pain-free people above the age of 30 and imaged their spines, there's a good chance that a large portion of them will show something "funky" with their results.  The same can be said for other areas of the body.  Unless you have an MRI result from a month or two before your symptom onset (which is never the case, because nobody ever gets MRIs done just for the heck of it!), then it's really impossible to draw a direct line from your results to your pain."

I want patients like the example above to stop carrying around their positive MRI results like a 100 pound gorilla on their backs.  If they view themselves as damaged goods, then it will surely slow their road to recovery.  We are made to move.  We stress our bodies all the time in myriad ways.  Like all things mechanical, we are subject to wear and tear.  But that's okay.  Unlike a car or some other machine, we humans are incredibly adept at self-repair and adaptation.

MRI's have value, don't misunderstand me.  They can help confirm a diagnosis based on a thorough subjective and objective examination.  But they should not be the "be all, end all" when it comes to figuring out why you're in pain.  And rarely should they be a first step along the path towards recovery.

If you ever find yourself with a positive MRI result, don't be too quick to hit the panic button.  The odds that you'll be destined for an operating room are not as high as that report might lead you to believe.