WHAT HAPPENED AFTER YOUR MRI?
It doesn’t happen all the time, but it is not uncommon for a patient to call our office to cancel an appointment because they went to their PCP, the PCP ordered an MRI and now they have to see a specialist. Sound reasonable?
There are multiple layers of “wrong” in this scenario. First and foremost is that, in most situations, we have already identified whether a disc bulge / sciatica was present based on talking to the patient and our exam finding. At this point, without any type of red flags, it is never, ever recommended to order an MRI this early in the treatment. Happens all the time, but apparently, those ordering the MRI are not reading the studies.
Not only is this a tremendous waste of resources, but it is well documented that this starts the patient on a MRI to epidural to surgery pathway, despite evidence that this is not the best pathway for the patient. It is also far too common for the PCP to steer the patient away from chiropractic care to a specialist–when chiropractic care is exactly what they need.
So what about the epidural’s effectiveness in the case of chronic (>12 weeks) radiculopathy (leg pain)? This particular study finds it worse than worthless—actually giving a small injection of saline was massively more beneficial than the steroid injection (Oswestry change after 52 wks– saline 14.3 points improvement, epidural 1.9 points worse). So basically, the epidural clearly made the patient worse as time went on.
The bottom line is that chiropractic care, for all musculoskeletal complaints, is the best place to go to get the best outcomes for your pain. Let the chiropractor decide if an MRI and epidural is appropriate.
DID YOU HAVE AN MRI FOR LOW BACK PAIN?
There are definitely times when knowing less is a good thing. It occasionally happens where a patient who has signs and symptoms of a disc herniation presents to our office.
Based on an exam and the history given by the patient, disc involvement (bulge, herniation, rupture, etc…) can be diagnosed and treatment started. A full blown disc bulge may take several days to start to show a response, but the outcomes are usually very good.
Sometimes, it is not a disc problem that is causing the patients’ low back and leg pain. Sclerotogenous referral from the hip (I really love the word “sclerotogenous”–makes me sound smart) or involvement of the fascia is also notorious for causing leg pain.
Sometimes, it may take a few days to be able to tell the difference. Certainly an MRI would be helpful, right? Not so fast…
You see, there is a large chunk of the population that has disc abnormalities on MRI (we can argue about the percentages, but let’s just agree that not all disc abnormalities on MRI cause problems). We have also seen that MRIs done before and some time after a patient has a disc bulge don’t change much, even though the pain may be gone.
This particular study contributes to what any chiropractor can probably tell you. MRIs increase the risk of having surgery. Sounds strange…I mean–how could having an MRI affect your back?
It’s the mindset and the potential diagnosis of a disc problem, even if the disc problem is not what is causing a patient’s pain.
In this study, when the primary care doctor or orthopedic doctor had a financial incentive to order an MRI (usually because the unit was installed in their clinic) the number of MRI for low back pain went up. In addition, in the orthopedic surgeon’s office, the number of patients getting surgery went up 34%.
Just something to consider the next time you THINK you need an MRI…
DO NOT DO THIS FOR A WORK INJURY!!
As a chiropractor, I can tell you that taking advantage of more complicated and “high tech” treatments for many, if not most, musculoskeletal complaints is bad news. Study after study shows that things like getting an MRI leads to higher chance of receiving an epidural. Receiving an epidural leads to a higher chance of having surgery. It becomes a cascade effect.
Most studies looking at chiropractic care for musculoskeletal complaints find that our care is at least as effective and definately cheaper. Especially when you focus on less medication, less imaging and certainly less surgery. Which always makes it difficult when someone tries to cut out chiropractic benefits to “save money.” Math wasn’t my strong point, but sure seems to make sense to keep chiropractic in the picture.
This particular study, while not looking at chiropractic care, did look at the opposite end of the spectrum. Researchers looked at patients with a herniated lumbar disc diagnosed in a hospital setting. Almost 42% of them did not return to the workforce full time. 42%!! The odds were worse if surgery was performed.
The bottom line is to seek chiropractic care FIRST. Care will be simpler, less costly, and your odds of returning to work will be highter.
