The March 25, 2013 edition of JAMA Internal Medicine tells the story: doctors are still ordering far too many low back MRI’s of questionable value.

Investigators first established “expert” guidelines that identified situations in which MRI’s were likely to yield useful clinical information.

Then they studied 1,000 actual MRI prescriptions to see if the case records conformed to the guidelines.  Fewer than half of the MRI studies were found to have been appropriate.

Useless MRI’s are expensive and can be harmful, because they cause unnecessary anxiety and lead doctors to even more questionable and more dangerous diagnostic procedures.  The bottom line is that we’re spending billions of dollars a year on a phantom process of diagnosis.

MRI and lumbar epidural injection

In a related article, researchers studied the use of MRI’s for patients who were candidates for epidural steroid injections.  These injections are commonly used in the medical community for people with back pain or sciatica who don’t seem to respond to other treatments.

In this group of patients, did the MRI help improve the outcome of the epidural injection?

Unfortunately, the answer is no.  Patients who received epidurals solely based on their physical signs got just as much pain relief as those whose physicians had a chance to review their MRI prior to treatment.

Palpation – the forgotten tool of diagnosis

What are the best ways to diagnose low back problems?  In a few cases, an MRI is needed.  But most people with back problems get more benefit from a physician who can listen attentively to your case history, palpate your muscles and joints, and assess your posture and functional movement performance.

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