MRI For Low Back Pain? Think Again

Low back pain imaging scans are costly and do not necessarily lead to relief says campaign

(RxWiki News) Many people experience back pain at some point in their life. Knowing when to seek medical care and when to practice self-care can be very tricky.

A non-profit organization established by the American Board of Internal Medicine has joined with leading medical groups to develop lists of tests and procedures for patients to discuss with their physicians as part of a campaign called Choosing Wisely®.

When it comes to low back pain, the foundation recommended most patients try self-care methods before receiving any medical imaging like MRI, CT scan or X-ray. Imaging should be sought right away in cases where nerve damage or other conditions are present.

"Ask your doctor about self-care methods for low back pain."

The campaign - which combined efforts from Consumer Reports, American Academy of Family Physicians and other entities - issued a document describing the nature of low back pain and imaging, with suggested ways to approach self-care.

According to Choosing Wisely®, low back pain is usually resolved within a month whether a patient receives imaging or not. In addition, imaging can often complicate recovery.

The authors of the document explained that there is no guarantee that any abnormalities found through imaging are the cause of the patient’s original pain. Finding and chasing issues that may not be the cause of pain can lead to unnecessary procedures that have their own recovery time.

One study cited in the document found that patients who had an MRI in the first month of experiencing back pain were eight times more likely to have surgery and had five times the medical expenses as those who did not have MRIs. The patients with MRIs did not have any faster recovery period.

Steven Kussin, MD, FACP, patient advocate and author of Doctor, Your Patient Will See You Now believes its not always best to treat abnormalities found in X-rays.

"Very often people have, and scans diagnose arthritis, collapsed vertebrae and bulging discs," said Dr. Kussin. "Most people aren’t aware of these findings and don’t need to be."

Dr. Kussin explains that the reports can cause patients and doctors to act too hastily when the initial problem would have healed on its own.

The authors of the study pointed out that MRIs expose patients to radiation which can increase cancer risk.

Patients can expect to pay between $200 and $290 for a low back X-ray, between $880 and $1,230 for an MRI and between $1,080 and $1,520 for a CT scan.

These prices may not reflect total costs. Treatments and surgeries that follow the imaging findings can add to the end price tag.

When should a patient seek imaging tests for low back pain? Choosing Wisely® suggested patients undergo imaging if there are any signs of severe or worsening nerve damage or if the patient has another condition like cancer or spinal infection.

Doctors and patients should also look out for a history of cancer, unexplained weight loss, fever, infection, bowel or bladder difficulties, abnormal reflexes and loss of muscle power or feeling in the legs, according to the document authors. These factors may warrant imaging for low back pain.

For those who do not meet the criteria for imaging, Choosing Wisely® recommended the following six strategies of self-care:

  • Stay active
  • Apply heat
  • Consider over the counter pain medicines like acetaminophen, ibuprofen and naproxen
  • Find a comfortable position to sleep in
  • Seek advice from a doctor
  • Consider alternatives like physical therapy, chiropractic care, yoga, acupuncture or massage

Back pain is the second most common symptom-related reason for clinician visits in the United States," said Dr. Kussin. "The new recommendations from Choosing Wisely will hopefully prevent the epidemic of CT scans."

Review Date: 
February 28, 2013