Does epidemiologic data affect how one treats painful discomfort? The authors of a recent study asked this question and hoped to determine whether the results of a magnetic resonance imaging test could affect how problems are treated. The conclusion was that a patient was less likely to include a prescription for narcotics to care for symptoms when such information included an MRI scan and the imaging reports.
Why would doctors treat differently based on the imaging reports? Seeking an MRI scan for back pain isn’t an automatic choice but a smart one; according to the American College of Physicians, such imaging is used for patients who experience lower back pain as well as symptoms that seem to suggest other underlying problems. For others, it seems that having routing imaging isn’t associated with significant benefits — in actuality, harm could come of it.
Looking into the inefficiency of this form of testing is vital to preventing harm and will impact how resources are used, both in the direct and downstream costs alike. At least in this aspect, further testing does not mean getting better care. By being more selective with imaging the back, better care can be provided while getting better results and spending less.
Another immediate issue to look for is that an MRI scan may show structural changes that are mistakenly believed to be causing the back pain. Following with that line of thought, the doctor and patient can both believe that the structure should be changed or will remove the tissue, which will therefore change the pain. While surgery can be a perfectly reasonable means of intervention for relief, it is not always the answer.
Adding information about the common findings of body scans in those without symptoms seems to be delivering a powerful message about the journey of the patient. At the core, this is what must be changed — the condition of the body must be better treated, along with the experience of the affected individual.
With this message, we are beginning to normalize. The main point to take back here is that the body and spine may change over time, but it is not necessarily causing a problem. A person who sits in the clinic likely has a problem that needs treatment, but this is not necessarily the work of an MRI scan. If one has been taken and shows that there is no serious problem, then great — still, many feel anxious and uncertain when there is no visible evidence explaining their agony. This makes perfect sense as the problem was not identified with the scan. In their mind, the scan had no meaning. This likely leads to further discomfort.
Now we must consider what we already know about the body and pain. Describing the mechanisms of pain and the biology that dictates it involves quite a number of systems in the body, as well as additional factors for pain like prior experience, stress, fatigue, movement, anxiety, perspective of the situation, as well as numerous other factors. All of this is biological, whether it’s a thought, an action or an emotion — it’s biologically rooted in the body. It is possible to use different dimensions of pain to construct a program that affects both the pain and all factors influencing it.
Having done this, it is next important to come up with an individual program to offer specific training that the individual needs to get the body doing what it’s used to doing. This does not include a scan but includes other techniques to improve awareness and body confidence, both of which are vital.
Finally, the individual should be monitored throughout the period, noting changes in function or pain under the right conditions. This helps us determine the next best course of action.
The debate on MRIs and whether one requires an MRI will continue, which is good; it is important to always question what we know so we can provide the best treatment for the individual patient.
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