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And nothing is worse for back pain than fear.

No one wants a false alarm, but whatвЂ™s the big deal about a few diagnostic red herrings? ItвЂ™s a worse problem than you might think in (at least) two major ways вЂ¦ДЇirst, X-rays and MRIs genuinely spook people! It strongly reinforces the idea that something might be broken or crooked, a common and extremely misguided idea about back pain (and many, many other problems 8). Stuart McGill, interviewed by John Childs for Evidence In Motion podcast (2018) WhatвЂ™s the big deal? Why is it so important to actually avoid using X-ray and MRI to diagnose back pain? I donвЂ™t believe radiologists should write a report without the context of the pain that the person presents with. So in showing the wounds and scars, no radioloist should be giving opinons as to what features correlate with pain until theyвЂ™ve seen the patient and assessed them and understood their pains. It shows the fresh wounds that may be related to their current pains, but it also shows all of the scars that theyвЂ™ve accumulated over the years.

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That image shows the full history of that personвЂ™s life. I think that the recommendation should now be вЂњstronger than strong, very strong, really extremely strong,вЂќ and the evidence supporting it can be considered вЂњbulletproof.вЂќ The authors labelled this recommendation вЂњstrong,вЂќ and believe the evidence to support it is вЂњmoderate.вЂќ The most important recommendation was that doctors should avoid giving people X-rays and MRI unless the clinical situation is really rather bad, such as severe and persistent neurological symptoms. Scientific journals are still publishing (and re-publishing) guidelines like these - perhaps eventually the message will get through! 7Д«izarrely, that message has not yet reached many therapists and doctors. 6 The lameness of MRI was pointed out firmly by the American College of Physicians and the American Pain Society in their 2007 guidelines for the management of low back pain. At that time, one study pointed out that almost half of MRIвЂ™s in California were вЂњmedically inappropriateвЂќ and profit motivated. It has been criticized at least as far back as the early 90s. The over-imaging debacle is official (and it has been for years) Or learn when to worry about back (and when not to). Got low back pain? See the advanced low back pain tutorial.

Wise use of MRI is great, but the common overuse and abuse of MRI is a disaster of over-medicalization. MRI also isn't even completely safe-injected contrast agents can cause severe allegric reactions, sometimes lethal. 4 Premature MRI is actually often worse than useless, scaring patients badly and doing real harm. But low back pain experts have long understood that you simply cannot reliably diagnose low back pain with MRI or with X-ray in isolation 3 - and trying to do so reliably raises false alarms that actually do harm. Radiology reports are usually written without clinical context, and results are often presented as if a spinal glitch is a diagnosis in itself. Zooming in on what MRIs show is doomed to diagnostic failure. Low back pain (like most chronic pain) is extremely multifactorial, and the spinal glitches MRI reveals are just one ingredient in a rich stew of risk factors. Diagnosis based mainly on such findings is usually misleading. Spines usually look worse than they are! Seemingly scary spinal degeneration is shown by MRI in high percentages of asymptomatic people. 1 2 MRI can shine when itвЂ™s actually needed and done well.Д«ut if MRI is a great power, itвЂ™s not being used with great responsibility: itвЂ™s not needed anywhere near as much as it is actually used, and itвЂ™s especially not needed for most low back pain. MRI especially is a miracle technology, no doubt about it - the ability to get clear images of soft tissues deep inside the body is valuable, and extremely tempting for everyone involved.

They donвЂ™t always make false alarms, of course. When it comes to diagnosing most back pain, MRI machines are like Monty PythonвЂ™s medical machinery that goes вЂњbing.вЂќ For back pain, MRI and X-ray are medical machines that make false alarms.

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