This is question we get a lot in clinic – a patient may come in with a simple mechanical lower back pain, and because it is new to them, and they are worried about their diagnosis, they want an MRI to be sure. The problem is, of course, MRI scans are expensive in both the private sector, and for the NHS to provide. If the hospital gave an MRI scan to every patient who wanted one, we’d have a very poor NHS, and a lot of very unremarkable scan results.
As a general rule, a scan is only required when the results of that scan have the potential to change the course of a patient’s treatment. For simple mechanical lower back pain, with no sciatica, and no previous history of pain, a scan is almost never required.
The following are areas of concern that may lead to a scan being requested;
You have RAGING Sciatica
Having sciatica doesn’t always result in a scan being requested. In fact, many people have sciatic symptoms in one leg – either pain, numbness or pins and needles – and don’t require a scan. If their symptoms show improvement within 4 treatments with an Osteopath, or over the counter medications can reduce their pain, a scan is not required.
A scan is recommended if a patient has severe sciatic pain in both legs at once, or the pain is not affected by analgesic drugs.
A scan is absolutely required if a patient loses control of their bowel or bladder function. This is a big red flag for health professionals, and will often result in an ambulance being called to take you to A&E.
Your pain is chronically recurring
Your latest episode of lower back pain has lasted for 12 weeks or more, without improvement. You have previously has several episodes like this, and would like to know a definite diagnosis for the root cause.
An MRI scan is a good option for these patients because it can pick up problems in the intervertebral discs, that an Xray wouldn’t be able to show.
The reason a scan referral may be appropriate for these patients is that they may be a candidate more invasive treatment option than Osteopathy or Physiotherapy – such as steroid injections, nerve root blocks, epidural, or spinal surgery.
You are over 55 and your pain is sudden and severe
If there are questions about the level of a patient’s bone density, and they have a traumatic injury followed by sudden and severe back pain, and MRI may be useful. Here, we want to determine if there is a spinal fracture causing the patient’s pain – and an MRI can be useful to tell the difference between an old, healed fracture and a fresh one.
You may be advised to have both an Xray and an MRI in this situation – so that your bone density and the level of degeneration in your spinal joints can be assessed.
Remember, even patients who are candidates for spinal surgery are advised to try conservative management of their symptoms for 4-6 weeks first. The spine is very strong, and it takes a considerable injury to deviate from a moderate treatment plan of manual therapy, like Osteopathy, rehabilitation exercises and pain-relieving medications.
If you have questions about your back pain, speaking to your Osteopath or GP will give you the answers you need for your individual circumstances.