Do I Need an MRI for My Back Pain?

Dave and Rob are with physiotherapist Adam Dobson discussing scans and in particular how MRI scans can and are used in connection with back pain. Scans are important but only for a small number of patients with back pain and Adam explains in detail the pathway and context that may lead to a scan being done along with reasons why a detailed clinical diagnosis is so important in this episode packed with great information and content. Its ultimately about the right scan at the right time and this is a great opportunity to find out more. KEY TAKEAWAYS 90% of back problems are not diagnosable on a scan and a scan will only be important for a small number of patients with back-related problems. Scans can be used to rule something out such as a fracture, cancer or an infection and may open up a change of treatment plan. If there is a good quality working diagnosis then imaging can create a potential additional step before treatment begins. Patients should know what a scan is likely to show, the implications of the findings and what it might change. Scans are highly detailed and show lots of things that may not be relevant and are common in lots of the population. These things are not predictors for pain or function in the future. Patients should be prepared and educated to help them understand imaging. If you’ve had a problem for less than 6 weeks, the nerves are working and there are no indicators for serious pathology there is a high chance your problem will resolve itself over time. It’s about the right scan for the right person at the right time The picture can change - If you are told you don’t need a scan it doesn’t mean you will never need one. If you have persistent and disabling pain there is something wrong but it can be about the factors involved and where best to focus effort with therapy and support powerful options. BEST MOMENTS ‘If it’s is unlikely to change the treatment plan and there is no evidence for serious pathology then there is a strong argument that imaging is not required’ ‘An MRI scan can be used as a reassurance about what’s not there’ ‘In collaborative working with the patient imaging is a malleable decision’ VALUABLE RESOURCES The Back Pain Podcast The Back Pain Podcast recommended products affiliate link Adam Twitter https://twitter.com/adamdobson123 What is sciatica booklet https://www.southtees.nhs.uk/content/uploads/ST1112-Sciatica-Booklet.pdf Handy information guides on back pain, sciatica, Cauda Equina, posture and more. https://www.southtees.nhs.uk/services/back-pain-triage-and-treat/patient-information-educational-resources/ Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173 Belavý, D. L., Quittner, M. J., Ridgers, N., Ling, Y., Connell, D., & Rantalainen, T. (2017). Running exercise strengthens the intervertebral disc. Scientific reports, 7, 45975. https://doi.org/10.1038/srep45975 Nature or nurture in low back pain? Results of a systematic review of studies based on twin samples P.H. FerreiraP.Beckenkamp C.G. Maher J.L. Hopper The 'Lived Experience' of patients having a Cervical or Lumbar MRI scan Armitage, Annabelle; Harland, NicholasPain and Rehabilitation - the Journal of Physiotherapy Pain Association, Volume 2020, Number 49, July 2020, pp. 57-62(6) Physiotherapy Pain Association Low back pain and sciatica in over 16s: assessment and management NICE guideline [NG59] Published date: 30 November 2016 Last updated: 22 September 2020 NHS website back pain website https://www.southtees.nhs.uk/services/back-pain-triage-and-treat/ National Low Back and Radicular Pain Pathway https://www.boa.ac.uk/uploads/assets/e26cc007-74c3-4b22-94e408dd54ac79da/spinal%20pathfinder.pdf ABOUT THE HOSTS Dave Elliot Dave is the owner of Advanced Chiropractic, a chain of Chiropractic and massage therapy clinics in Essex, UK. Dave still sees patients during the week but has been working hard to talk to as many experts in the field of back pain as possible to help distil all the information and bring it to you in this awesome podcast. You can find Dave on any of the Advanced Chiropractic social media platforms, or you can contact him at hello@thebackpainpodcast.com if you have any questions for him. -Instagram Rob Beaven Rob owns and runs a multidisciplinary clinic, The Dyer St Clinic in Cirencester Gloucestershire. His team of Chiropractors, Physiotherapists, Osteopaths, Doctors and podiatrists all collaborate on thousands of back pain patients every year. Alongside Dave, he has worked hard to bring to the table experts across all industries to give you the low down on back pain, with steps you can implement today to start feeling better. -Instagram -Twitter CONTACT METHOD Instagram Twitter Facebook hello@thebackpainpodcast.com Support the show: https://thebackpainpodcast.com