An MRI for a lower back pain can be bad medicine; here’s why.

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Doctors will tell you that the longer you speak with a patient, they are more likely to tell you what is wrong with them. A thorough lower back history should also include questions about your feet, knees, shoulders and even your neck.  A healthcare provider should also ask about your exercise habits as well as previous episodes of pain. Primary care doctors see many patients with lower back pain which is one of the top 5 conditions seen by primary care.  Chiropractors are seeing a growing number of back pain sufferers as the current medical evidence supports the methods they use to treat back pain. There is also a long history of patients relying on chiropractors because their approach to care has helped them in the past get relief more effectively than medical approaches to the problem. Primary care doctors understand that patients want relief as well as an imaging study, with the most common being either an x-ray or an MRI.   Primary care manages back pain by offering medication while a patient waits for the test results which often delays pain-relieving treatments.   This type of management has made the MRI for back pain the most overutilized medical service to offer little or no benefit to back pain sufferers.   Of course, overordering an MRI is not limited to just back pain, but also for neck pain, arm pain, and even sciatic pain.  The current medical evidence now suggests that imaging such as an MRI, as well as medications and referral to higher-level medical providers,  should be a last resort. The medical protocol of having a patient wait for the result while taking medication is hardly efficient, or adherent to evidenced-based care.  An MRI is a gateway to higher-level medical providers, which increases risk and cost while offering little benefit to most patients other than to find out how much wear and tear they have experienced over the years. The chiropractor, on the other hand, will assess how the patient moves and functions while evaluating why the patient hurts during a functional examination. Patients are usually treated the same day and are usually feeling better within a couple of visits.  Chiropractors use methods such as spinal and extremity manipulation, myofascial release and exercise instruction to improve how a patient moves.  Since back pain is movement-based, better movement means less pain. Sometimes, foot orthotics are helpful if the patient's back problems began in their feet. The chiropractic approach was supported by the Annals of Internal Medicine in February 2017 which suggested that conservative approaches should be used first and that more aggressive or invasive approaches and imaging should be done last, along with medication usage. Medical imaging may not be valuable for most back pain sufferers.

Doctors should practice evidence-based care, shouldn't they? 

Doctors should follow an evidence-based approach to care. The best evidence suggests imaging offers little value for most patients when evaluating someone with lower back pain.  On the other hand, doing a good exam and then treating what you find in the absence of drugs is what the current evidence supports.  It also supports movement-based treatments as an initial approach to care, such as chiropractic manipulation, myofascial release and exercises. Chiropractors will typically order an MRI once they have performed a series of visits on a patient.  Typically this will last from 6-9 visits and patients are expected to improve by 50% minimally.  If not, the doctor will order an MRI to determine why a patient has not improved.  Most patients improve within the first 6-9 visits, making an MRI unnecessary in most cases. Medical costs have risen yearly, partly due to the overordering of tests such as an MRI.   From a cost perspective, an MRI may cost more than the management of an entire episode of back pain by a chiropractor. The chiropractic approach to back pain management has received high marks from Consumer Reports and numerous other sources.

What will it take to reduce the amount of MRI scans?

Insurance companies such as Optum have looked at their data and chiropractic management reduces the ordering of MRI scans, while patient satisfaction remains high. Insurance carriers have made it more expensive to visit chiropractors as well as physical therapists; is this driving the cost of care higher?   According to Optum Health who has collected many years of data, the answer is yes.  They are now considering making it cheaper to visit a chiropractor first, which will eliminate many MRI scans.

How can the patient make the right choices?

When you are in pain and have not slept, it is also likely that you are not thinking clearly and you are probably scared and very uncomfortable. Seeing a chiropractor for the first time may be scary for some, however, the evidence clearly supports chiropractic as a first intervention for lower back pain.  Feeling the difference from an adjustment has converted many patients on seeing a chiropr actor first for back pain and other problems in the musculoskeletal system. The chiropractic approach of holistic care has a growing following.

Most people feel better after seeing a chiropractor first.

Chiropractors will often help their patients feel and function better quickly reducing patient anxiety about problems that may offer easy and uncomplicated solutions. The old idea of patients expecting that they receive medication while they wait for the results of a test with regards to back pain needs to change. The reasons for why you have a condition such as back pain are usually found on a thorough examination, with an MRI playing a supporting role after someone does not improve. Patient expectations change with education. Insurance companies also know that financial incentives if done properly can reduce the number of MRI scans while sending patients for a more cost-effective type of care.  An idea would be to make it mandatory to see a chiropractor first while making it less expensive for an acute lower back pain episode, instead of the current method of using a third party administrator to make the doctor's office jump through hoops to get the test approved. Not ordering an MRI first is good medicine for a lower back problem. Directing primary care providers to refer back pain patients to chiropractors and therapists immediately while avoiding a medication prescription is also good evidence-based medicine. Feel better in as little as one visit, see a chiropractor first for back pain.