Do I Need an MRI for my Back Pain?

Uncomplicated low back pain does not always need an MRI evaluation. My clinical expertise is in spinal pain, particularly low back pain. Frequently new patients will ask if I think they need an MRI for their low back pain. Some patients even come in with an MRI scheduled for later that week. Even when they have had pain for only a few days, they have an MRI scheduled already.

There are some serious concerns about that pattern.

1. Most low back pain will resolve within 4 to 6 weeks with conservative care (including chiropractic care). Save your time and money and post-pone that MRI and more likely than not, you will get better and not need the test.
2. MRI’s are incredibly expensive and only provide diagnostic assistance. They don’t help fix the problem. Too often doctors are ordering MRI’s like casting a fishing net, “Hey, let’s order an MRI and see what shows up.” That is not appropriate use of insurance funds. I think if doctors had to share the cost of the MRI with the patient, they would be ordering a lot fewer. Sometimes I wonder how many doctors have a financial incentive to order more MRIs. If an MRI is ordered to rule out a specific suspect disease, or confirm a diagnosis, then it is more appropriate.
3. MRI’s are too sensitive. Many studies have looked at the false positive rate of MRI. That rate hovers about 30%. What that means is 30% of the MRI’s will show evidence of disc injury even when the patient has no symptoms. I’ll translate that for you into a clinical case. Mr. Jones walks into my office with really bad sciatica that started a week ago. He is taking some pain meds from his medical doctor and has an MRI scheduled for later today. He has the MRI done and the report shows a bad disc herniation in the low back. What conclusions to we all make? That the disc herniation is causing his sciatica. Right? Wrong. In at least 30% of the cases, that disc injury was there prior to the sciatica. The disc injury just happens to be there now, and we incorrectly point the finger and say ‘A-ha, that is the source of your pain.” If we did an MRI on him two weeks ago, before he had any pain, there is a 30% chance that there would be a disc injury— even though he had no pain at that time.
4. MRI’s tend to lead to surgery. Stanford professor Loren Baker studied how an increased number of MRI machines in an area increased the number of MRI’s being ordered by physicians. This, in turn, increased the number of surgeries when compared to similar demographic regions. You can read the study at yourself. You can find it at: Magnetic Resonance Imaging And Low Back Pain Care For Medicare Patients Health Aff October 2009.

I am not anti-MRI. I have ordered plenty in my career. There are times when an MRI needs to be done right away. But those cases are uncommon. I just feel that we need to be a little more judicious in how we order them. Our health care system in going broke. Families are carrying a greater share of the healthcare costs, with increased deductibles and copayments. If we can save a few thousand here and there, it will all add up.

If you are suffering from lower back pain or sciatica and you are considering and MRI, stop by my office for a consultation and let me examine you. I will provide an accurate diagnosis of your condition.

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