| BBC Health carries an article about a review of six | | | | management programme may be necessary to |
| trials covering 1800 patients which concluded that MRI | | | | address all the aspects of having long term and |
| scanning does not help in the management of normal | | | | chronically disabling pain. |
| low back pain and should be reserved for specific | | | | Reassurance is not an effective way of dealing with |
| conditions such as nerve root lesions, infections and | | | | patients' health anxiety and MRI scanning has been |
| tumours. The outcome of low back pain is not | | | | shown to be ineffective in accomplishing this goal. |
| improved by the use of scans and there were no | | | | Abnormal findings are found in the spines of people |
| differences between the two groups, one group with | | | | without pain symptoms so it is difficult to decide which |
| typical management and the other having an MRI scan | | | | changes are relevant to the presenting symptoms and |
| at some stage. This was the same for the early | | | | which are just incidental. It is vital to avoid creating |
| outcomes and for up to a year after the onset of | | | | unhelpful attitudes and images in the patients' minds |
| acute low back pain. | | | | about what is occurring inside the spine. Sufficient time |
| Patient expectations are a very strong driver of | | | | and communication skills are necessary to achieve a |
| imaging for low back pain, either x-rays or magnetic | | | | good understanding. |
| resonance imaging, and many patients ask their | | | | Explanations to patients are fraught with difficulties and |
| doctors and surgeons for this, thinking it will indicate | | | | many fall into what I call concepts without explanation, |
| what is wrong with their backs. Scanning is something | | | | where the explanation is given to the patient with little |
| you can do but studies indicate that MRI rarely shows | | | | or no care or checking as to what they take away |
| up an important finding in a person's back which was | | | | from it. If we give them a concept to think about we |
| not already suspected. Communicating with the | | | | have a responsibility to help them understand and fit it |
| patients about the treatment plan and answering their | | | | in to their attitudes and beliefs about their back pain in |
| questions is harder. | | | | a realistic way. If we get this wrong by being careless |
| The numbers of magnetic resonance imaging scans | | | | with our communication this can have important and |
| has been steadily increasing, perhaps because it is a | | | | negative consequences. |
| relatively easy thing to request rather than taking the | | | | When we refer a patient for an MRI scan we should |
| time to answer awkward questions and correct the | | | | give careful counselling as to the limits of the imaging |
| misconceptions of the patient. We explain the findings | | | | or we will store up disappointment for later. The scan |
| and their meaning poorly in many ways and the scan | | | | should be small part of the overall strategy for |
| findings throw up many questions which are difficult to | | | | managing the pain and a surgical opinion should be |
| answer. Patient expectations should be addressed. | | | | available for explanation, interpretation and a decision |
| The history and examination of the patient should point | | | | on operative management. Patient expectations need |
| clearly towards whether the problem is mechanical | | | | to be carefully managed as to what the scan might |
| low back pain or whether there is a worrying element | | | | show and how the findings might be handled or when |
| to the presentation. Scanning should only be requested | | | | the negative results come in there will be frustration |
| if there is a significant positive reason for doing so, | | | | and disappointment. |
| rather than just a lack of imagination or an inability to | | | | Low back pain management is complicated and need |
| manage the patient's condition. | | | | time and good communication skills in the health |
| Patient education is a vital part of the management of | | | | professionals managing these types of condition and |
| back pain, explaining the reasons for pain, the reasons | | | | many other pain conditions. MRI scanning can be very |
| for not ordering a scan and the treatment path to | | | | useful in identifying disc prolapses, degenerate discs |
| follow, with a trial of manual therapy, acupuncture and | | | | and infection or tumour. For mechanical low back pain |
| a structured programme of exercise. A pain | | | | it has a very limited role. |