MRI scans for low back pain – when are they useful.
Lower back pain is common with almost all of us suffering from it at some stage in our life. Most times it settles fairly quickly and other times it responds to treatment. Scans or investigations usually in the form of MRI or CT are recommended when it doesn’t settle in an acceptable timeframe or your physio and doctor indicate it is recommended earlier.
The purpose of this blog is to reduce fear or concern if you have scans that show pathology. Although any pathology seen on imaging can be responsible for your pain, it doesn’t have to cause pain. The following table is from a systematic review in the American Journal of Neuroradiology. It looks at lots of research studies where they have scanned the lower back in people who don’t have any pain. The table below shows the % of people that when they had scans they found pathology BUT these people did not have any symptoms or low back pain. In other words pathology is a common finding in people who do not have lower back pain.
|Disc Annular Fissure||19%||20%||22%||23%||25%|
|Facet joint Degeneration||4%||9%||18%||32%||50%|
Brinjikji et al, 2015. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol 36:811–16 Apr
The highlights in the table show that 37% of those in their 20’s had some disc degeneration but no pain. In the 30s age group it had increased to 52% but again no pain. If a scan is likely to show normal pathology associated with age but doesn’t mean you will have pain and it’s also not going to change the treatment, then scans are not recommended. So if you do have lower back pain, scans are not usually recommended in the early stage.
If you have low back pain, firstly you should manage the pain with simple analgesics such as paracetamol; stay active as tolerated and occasionally use positions that offer short term relief. In acute low back pain, physio can help with the posture and movement means to reduce pain.
There are times when you do need to have scans straight away and your doctor or physio will identify those occasions. For example if your pain is severe, worsening or if you experience neurological symptoms such as weakness, tingling or numbness, then you need to be assessed by your physio or doctor.
If you have back pain and it is affecting your ability to be active then contact us for an appointment. We believe in an active approach to treating low back pain. Contact us on 4921 6879.