I recently attended the annual Australian Pain Society (APS) conference in Adelaide. A commonly agreed message from presenters is that once you have chronic pain, imaging does not help. Not only are X-rays, CT scans and MRIs not helpful in identifying the causes of chronic pain, but excessive use may also put patients at risk of overexposure to harmful radiation. A study in 2010 of patients with low back pain (LBP) showed that those who had an MRI within the first month did not recover any faster than those that didn’t have imaging, however they were 8 times more likely to have back surgery.
One presenter even went so far to say that imaging is iatrogenic particularly in LBP i.e. that it helps create chronic LBP. Why? In chronic low back issues pain is not a measurement of tissue injury – we just think it is. Degenerative changes are frequently seen on images however are commonly asymptomatic and generally a normal sign of ageing. As a rule of thumb images do not explain chronic pain and spinal imaging is not associated with LBP prognosis. The concern stems from how image findings are reported back to the patient. Poor communication about what is seen may lead to increased fear of re-injury and as such decrease the likelihood of a good outcome. Unfortunately poor communication is common. However, for want of a solution, health practitioners and their patients in pain still frequently use and request imaging as part of a LBP work up.
Take home message: if you have chronic LBP, imaging won’t help identify the cause of pain and may increase the risk of surgery! Try a more conservative approach of physical therapy, exercise, appropriate nutrition and mindfulness.