Do You NEED An MRI? Probably Not!
I cannot tell you how many patients come in to the office asking if we need to order an MRI to figure out what is wrong with their lower back. Almost every time I tell them that I don't think that I will need to see an MRI to know what we need to do to get them feeling better, and almost every time the patient stares at me in disbelief. As a matter of fact, when a new patient brings in an MRI for me to review, it is the last thing that I look at before I explain to the patient why they have the pain that they have. Do you know why? As I explain to the patient "I treat people, not pictures!" There is quite a bit of research out there that shows that MRI findings DO NOT closely correlate with pain. As a matter of fact, a study showed that 40% of people that have NO lower back pain actually a herniated disc in the lower back. Not only do MRI findings not correlate with pain, but they are known to have a "nocebo" effect!
If you are not aware of the nocebo effect, it is the opposite of the placebo effect, that we are all so aware of. The nocebo effect occurs when a patient experiences negative effects from something that should cause no harm. When an MRI shows a disc herniation the patient has a tendency to increase their awareness of their pain. The more aware that we are of POTENTIAL causes of our pain, the more likely we are to feel that pain!
Dr. James Andrews, who is one of the best known sports orthopedic surgeons in the world, was recently quoted as saying "If you want an excuse to operate on a pitcher's throwing shoulder, just get an MRI." And Dr. Bruce Sangeorzan, vice chairman of the department of orthopedics and sports medicine at the University of Washington, said "An MRI is unlike any other imaging tool that we use. It is very sensitive, but it is not very specific. That's the problem." These gentlemen know what they are talking about and you should take their words at face value!
Here is a link to an article from The New York Times Health Blog
Movement is my Medicine,
Dr. William "Chip" Bleam