The College of Physicians has just set the new guidelines for doctors who treat lower back pain and the recommendations are startingling. “Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain.” The evidence for this recommendation is overwhelming.
“More than 85% of patients who present to primary care have low back pain that can not reliably be attributed to a specific disease or spinal abnormality. and classification schemes frequently conflict with one another. “Moreover, no evidence suggests that labeling most patients with low back pain by using specific anatomical diagnoses improvements outcomes.” “Routine advanced imaging (computed tomography (CT) or magnetic resonance imaging (MRI) is also not associated with improved patient outcomes and identifies many radiographic abnormalities that are poorly correlated with symptoms but could lead to additional, possibly unnecessary interventions.”
In a nut shell, the College of Physicians have just arrived at the same conclusion I did about 18 years ago. Namely, using MRIs to identify the cause of lower back pain or any other pain is invalid. The comical part of the guidelines is that they are simply recommending clinical evaluations to come up with the same potential causes of lower back pain versus using the MRI to come to these findings. Think about the irrational nature of this thought process. MRIs provide no correlation between the findings and the cause of low back pain but utilizing clinical evaluations that come to the same conclusion is better. The use of a straight leg test to come to the false conclusion that sciatica is the result of a herniated disc in the lumbar region is somehow more comfortable than the false MRI finding identifying a herniated disc. I guess at least it is saving money on the diagnostic test. Unfortunately every treatment protocol that follows that false diagnosis will not work which will still lead to the same results of more people having more intense pain for longer periods of time.
They seem to recognize that those radiologic abnormalities like herniated disks, stenosis, arthritis and spondylolisthesis are poorly correlated to pain but that this does not help them reach the conclusion that these abnormalities are not causing pain. It absolutely blows my mind. No relations between finds and pain and yet no jump to the logical conclusion that these findings are not the cause of pain. They simply exist due to slow, progressive deterioration of the tissues which creates no symptoms. The cause must be due to another tissue creating the pain signal and these findings present simply because they are in the same region where the pain is experienced.
They are getting so close to the finish line. At least now there is recognition of a major medical body regarding the improper use of diagnostic tests to attempt to establish the cause of pain. If you are a patient and you read this post, please heed the warning of this medical body. Do not accept these results as identifying the correct cause of your pain. Now instead, be open to the fact that there must be another cause of your pain.
Be open to the potential cause of your pain being muscle weakness or imbalance. Remember most pain is due to tissue damage. The pain is an attempt by the tissue in distress to identify to the brain that the tissue is in distress and that it requires intervention. Very simply, if you touch your lower back or neck and you press down and the pain increases where you are pressing, that is a sign called point tender pain. It means that the tissue you are touching is the tissue in distress and it is the one that requires intervention. If you are pressing on your neck region or lower back region you should realize that you are most likely pressing on muscle. It is muscle that is in distress and it requires the intervention. That intervention is most likely targeted strength training.
Do not get bullied by your physician into getting an MRI or x-ray to identify the cause of your back pain. The College of Physicians has set their guidelines and the are now recommending no more x-rays or MRIs based on significant evidence that there is no correlation between these findings and pain. Now find a medical practitioner like me who has been identifying the true cause of pain without these tests, strictly through clinical evaluation for almost 18 years. I assure you your results in resolving your pain will be much better.