When Should You Have an MRI for Your Back Pain?


MRIs can lead too quickly to surgery
Skeptics also worry that MRIs can put a patient on a slippery path to the surgical ward. "It's been well known since soon after MRIs came out that there's a lot of 'normal abnormals,'" says Bradley Rosen, DO, an osteopathic physician and physical medicine and rehabilitation specialist based in Germantown, Md. (Osteopathic physicians focus on the treatment of the musculoskeletal system.) "It may be a knock against surgeons, but these abnormal MRIs can give them something to operate on—and that's how they make their money."

The better option for a patient presenting with new back pain? Basic, less sexy solutions, such as exercise, over-the-counter painkillers, and time. Most low back pain problems will clear up with basic treament in four to six weeks, rendering an early MRI, CT scan, or X-ray unnecessary.

Of course, some problems don't resolve. Roger Chou, MD, associate professor at Oregon Health & Science University, says "the exception is when you have a pinched nerve—when you have sciatica or spinal stenosis, which is the narrowing of the spine canal," says Chou. "If you aren't getting better for four to six weeks and the symptoms are pretty severe, it may be reasonable to get an MRI." Dr. Chou also points out that a physician may order an MRI when there are "symptoms of a serious underlying condition" such as cancer or infection.

Dr. Goldstein warns that even if a doctor does order an MRI, it shouldn't be their only diagnostic tool. Back pain can be a complex interplay of different factors, all of which need to be investigated.

"It's important for physicians and patients to understand that we don't treat MRIs. We treat patients," says Dr. Goldstein. "They have families, they have jobs, they have hearts, they have kidneys, they have stresses, they have a life, and you have to treat the entire patient. If you treat the MRIs, you'll have a lot of unhappy patients."

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Lead writer: Suzanne Levy
Last Updated: April 30, 2008

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