A common recommended “don’t” of the Choosing Wisely campaign in the United States, Canada, and now Australia is getting imaging for nonspecific back pain.
The initiative, which identifies tests, treatments, and procedures that have little benefit but may lead to harm, is indeed wise in highlighting the dangers of such scanning.
The recommendation is based on several major studies—from 2007, 2008, 2009, 2010, 2011, and 2013. But while not imaging might be based on solid advice, it’s old advice. The recommendation has been around for years—ever since it was discovered that the state of your back MRI doesn’t relate very well to whether or not you have back pain.
Still, They Come …
Nonetheless, the vast majority of people who turn up to participate in our research, two or three weeks into an episode of back pain, bring with them a bundle of MRIs tucked under their arm and a somewhat worried look on their face.
When we ask referrers about their almost ubiquitous MRI use, the most common answers tend to be “the pain was just so severe and the patient really wanted it,” “better to be safe than sorry,” “no harm in just excluding the nasty stuff,” and the clanger—“lucky we did—there are some pretty major problems in there.”
And here is the rub. There’s no doubt that MRI is a really powerful tool. I am one of those who is gobsmacked by the detail these things provide and the magic of being able to see inside ourselves. I’m also pretty convinced that MRIs don’t carry physical risks.
So what’s problem? If people can afford it or if the pain is really severe, it can’t do any harm, right?
