MRI
When it came to the diagnosis and treatment of neck and back pain, physicians were eager to apply this new procedure.
At first it seemed to work well. People with back pain were found to have many abnormalities on their MRI scans.
Relatively few people were found to have tumors or infections in or around the spine, but there were tons of people who had problems with the discs, the flat round cushions of tissue that separate each of the spinal vertebral bones.
It was extremely common to see disc space narrowing, degeneration of the discs (called degenerative disc dis- ease or DDD), and bulging or herniated discs that extended toward the spinal nerves or cord.
Radiologists also identified spinal stenosis (a narrowing of the spinal canal), facet arthropathy (arthritic changes in the joints between each of the vertebrae), mild forms of spondylolisthesis (where one vertebra is misaligned from the others), and a host of other changes.
MRI AS NOCEBO
MRI tests can lead people to the false belief that they are physically damaged when doctors interpret normal abnormalities as the cause of pain.
The nocebo effect is lurking inside routine radiology reports. Here are two studies that quantified this effect.
One study compared outcomes in two groups of people with back pain. The first group was given a reading of their MRI scans describing all the abnormalities.
The other group was told that their MRI abnormalities were also seen in normal, healthy people.
At a six-week follow-up, those in the first group expressed more fear about their backs being damaged, felt more pain, and were less functional than the second group.
That group was also more likely to have a back injection or surgery. In a British study from 2021 of 306 MRIs, 65% had negative effects due to the over- diagnosis of MRI readings, in the form of referrals for procedures that were unnecessary.
The idea that the information on an MRI could be misleading is jar- ring to most people, and most doctors, today.
The MRI myth is just the beginning of back pain myths.