Magnetic resonance imaging is an astonishingly successful technology which gives us great insights into the internal structure of the body, allowing accurate diagnosis and planning of treatment with a high degree of certainty. However, as recently flagged up in a BBC Health news article, MRI scanning can be positively harmful in the management of low back pain and should only be used if there is a suspicion of a serious underlying condition. Two groups were compared, one of which was scanned and one not, with results not differing over the short or longer term.
Doctors refer people for magnetic resonance imaging for a variety of reasons, one of which is the patient's expectation that the scan will show what is wrong with their back and lead to a successful therapy. However, an obvious and treatable cause is rarely found on a scan and it more important to answer the patient's many questions and clearly indicate the treatment strategy to them.
The incidence of MRI scanning as a choice for back pain investigation is increasing, perhaps because it is an easy thing to request. However it often raises more questions than it answers and leads to particularly difficult questions and misconceptions in patients' minds. Many of us explain the findings to patients using the wrong terminology. Our job partly is to reduce patient expectations about what scanning can achieve.
The patient history of the presenting condition and the physical examination should give a clear indication of the type of back pain being dealt with and MRI scanning should not routinely used to confirm this. Scanning should occur for nerve root pain or to investigate the possibility of a serious condition rather than just to have a look at what is there.
The underlying rationale for low back pain and the need or otherwise for imaging including MRI scanning should be part of patient education. The strategy should be laid out which includes a graded exercise programme, acupuncture and manual therapy course. A small proportion of back pain sufferers become chronically disabled and require a pain management programme to address their issues.
It's too easy to be offhand in communicating with the patient when we are explaining the scan, what it means for the spine and for the treatment choices. We should not give patients concepts without explanation in the sense that we tell them things they interpret and make part of their world view without a careful explanation and answering of any questions they might have about the new information. An incorrect explanation can create damaging images and beliefs which limit what a patient will do to help the self management of their pain.
Much of the explanation to patients comes under the category of what I call concepts without explanation. We give a concept, a way of seeing things, to patients but we don't give them the accompanying information they need to make sense of it and incorporate it helpfully into their view of their back pain and its management. This is a very bad idea and has very unhelpful consequences as the patient's interpretation of their condition informs their whole self-management.
Careful explanation must be given if we agree to scan a patient otherwise the answers we give will bring their own problems. Once we agree to scan someone there must be a plan for what we are going to do next. There should be an opinion we can access without delay as an MRI scan on its own has little relevance, it needs to be interpreted, explained and acted upon. Much of the frustration comes from the patient's expectation about what can be shown on the scan and when, as is overwhelmingly the case, little of diagnostic value emerges, there is a feeling of what's next?
Doctors refer people for magnetic resonance imaging for a variety of reasons, one of which is the patient's expectation that the scan will show what is wrong with their back and lead to a successful therapy. However, an obvious and treatable cause is rarely found on a scan and it more important to answer the patient's many questions and clearly indicate the treatment strategy to them.
The incidence of MRI scanning as a choice for back pain investigation is increasing, perhaps because it is an easy thing to request. However it often raises more questions than it answers and leads to particularly difficult questions and misconceptions in patients' minds. Many of us explain the findings to patients using the wrong terminology. Our job partly is to reduce patient expectations about what scanning can achieve.
The patient history of the presenting condition and the physical examination should give a clear indication of the type of back pain being dealt with and MRI scanning should not routinely used to confirm this. Scanning should occur for nerve root pain or to investigate the possibility of a serious condition rather than just to have a look at what is there.
The underlying rationale for low back pain and the need or otherwise for imaging including MRI scanning should be part of patient education. The strategy should be laid out which includes a graded exercise programme, acupuncture and manual therapy course. A small proportion of back pain sufferers become chronically disabled and require a pain management programme to address their issues.
It's too easy to be offhand in communicating with the patient when we are explaining the scan, what it means for the spine and for the treatment choices. We should not give patients concepts without explanation in the sense that we tell them things they interpret and make part of their world view without a careful explanation and answering of any questions they might have about the new information. An incorrect explanation can create damaging images and beliefs which limit what a patient will do to help the self management of their pain.
Much of the explanation to patients comes under the category of what I call concepts without explanation. We give a concept, a way of seeing things, to patients but we don't give them the accompanying information they need to make sense of it and incorporate it helpfully into their view of their back pain and its management. This is a very bad idea and has very unhelpful consequences as the patient's interpretation of their condition informs their whole self-management.
Careful explanation must be given if we agree to scan a patient otherwise the answers we give will bring their own problems. Once we agree to scan someone there must be a plan for what we are going to do next. There should be an opinion we can access without delay as an MRI scan on its own has little relevance, it needs to be interpreted, explained and acted upon. Much of the frustration comes from the patient's expectation about what can be shown on the scan and when, as is overwhelmingly the case, little of diagnostic value emerges, there is a feeling of what's next?
About the Author:
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for Physiotherapists in Coventry.
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