Written by Raviinder Parmar, MD
Back pain is very common. Studies show that this is among the top 5 reasons adults visit their primary care doctors.
Many common causes of back pain don’t show up on MRI
There are a variety of common causes of back pain. Some of these will generally be visible on an MRI, including herniated spinal discs and fractures of the vertebrae, which are the small bones of the spine. However, there are also many that may not cause MRI findings, including:
Muscle strain. The damage to a muscle from muscle strain is generally not visible on an MRI. However, this type of injury can lead to severe symptoms, such as pain and stiffness.
Ligament strain or other soft tissue injuries. Similarly to muscle strain, these injuries will generally not cause significant MRI findings, but the symptoms that they cause can be severe.
Osteoarthritis of the joints between the vertebrae. Osteoarthritis is the degenerative, wear-and-tear type of arthritis that commonly occurs with aging. Signs of osteoarthritis can appear on an MRI, especially in more advanced stages; however, MRI has been shown to miss more than a third of osteoarthritis cases. If a patient’s pain is caused by osteoarthritis, it might not be seen on the MRI.
Should an MRI be done for back pain?
It’s not uncommon for patients to request an MRI for back pain. They often hope that a treatable cause of their pain will be found. They also often believe that MRI findings will validate their pain experience. Similarly, those financially involved in the patient’s care may want an MRI to validate the patient’s pain claims.
However, it’s important to recognize that back pain doesn’t always lead to significant MRI findings. Even if a person with back pain has a normal MRI, this doesn’t at all invalidate their claim of back pain.
The American Academy of Family Physicians recommends against using imaging in patients with low back pain in the first six weeks unless certain red flags are present. This is because the MRI won’t show many common causes of back pain. In addition, most cases of low back pain get better on their own within six weeks without intervention.
How do you know if someone is malingering?
In some cases of back pain, there’s a need to prove that a particular patient is in significant pain. For example, when deciding whether to prescribe pain medications, clinicians may want to be sure that these are truly warranted. Insurance and worker’s compensation adjusters may also want to be sure that a patient truly has pain.
Pain is a perception caused by the nervous system. Although pain can be correlated to tissue damage, high pain levels can also occur without major tissue damage or after the damage has healed. It’s also possible to have tissue damage without pain.
Unfortunately, there’s no scientific way to measure pain. Because patients can have back pain without significant findings on an MRI, it’s not possible to use MRI findings to determine whether or not a patient legitimately has pain. It’s nearly impossible for medical professionals to distinguish between malingering and legitimate pain, particularly in the setting of an injury that could conceivably have led to pain.
