Do MRIs Help or Hinder?

MRI scans for low back injuries among workers may delay recovery

(RxWiki News) The use of complex diagnostic tools is on the rise among injured workers. Imaging can be great for understanding the internal structures of the body. However, when it comes to low back pain, imaging may be a costly and time consuming distraction.

A recent study evaluates the link between early imaging and disability status one year after patients suffered from acute low back injury.

The study found that early imaging of the injury signified an increased length and chance of disability in patients, but it did not affect pain intensity nor quality of life.

"Speak to your doctor about any back pain."

Lead author, Janessa M. Graves, MPH, PhD, and team with The University of Washington monitored 1226 participants in Washington State with nonspecific lower back problems with related worker’s compensation claims.

All participants were 18 years old or older and had an accepted claim between July 2002 and April 2004. The participants also missed at least four workdays due to the injury but were not hospitalized.

Sprains were diagnosed in 77.9 percent of the participants. Radiculopathy, nerve inflammation that results in pain, was seen in 22.1 percent of the participants.

Information regarding date of injury, wage replacement benefits and type of job was collected from the worker’s compensation data.

Two to three weeks after the injury and after one year, the participants were interviewed. The interview questions ranged from overall and injury-specific health status to work and personal information.

The participants completed the Roland-Morris Disability Questionnaire to determine any physical disability caused by the low back pain.

The 36-Item Short Form Health Survey (SF-36) was used to measure health-related quality of life, mental health status and predict long-term disability of participants.

Workers pain intensity was assessed at each interview using a modified version of the Graded Chronic Pain Scale.

Of the 1226 patients, 18.6 percent of the study participants received a magnetic resonance imaging (MRI) within six weeks of incurring the injury and 15.7 percent received an MRI after six weeks from when the injury took place.

Thirty-nine percent of radiculopathy patients underwent early MRI testing, or testing within six weeks of injury. Only 13 percent of those with sprains received late MRI testing, or testing after six weeks of injury.

The participants who were given early MRI treatment had different levels of pain, function or psychological factors, including ruminating over the pain, than those who did not receive an early MRI.

The researchers found that receiving an early MRI did not make a difference in pain intensity or SF-36 scores at one year after the injury but was associated with greater functional disability in patients with sprains.

Those with sprains who received early imaging were twice as likely to still be on disability at the one year mark. Those with radiculopathy who had an early MRI did not have an increased risk of long-term disability.

The longer time frame of disability may be because early imaging means more attention is being paid to the patient’s health care resulting in more time away from work.

MRI scans often reveal other abnormalities from aging or normal wear and tear of the spine that have little to do with the source of the pain. Healthcare professionals and patients may spend time chasing these abnormalities with little result while the cause of the pain is healing on its own.

This can add significantly to healthcare costs and loss of productivity..

The study’s authors suggest a randomized controlled study is needed to determine the best approaches to treatment and recovery for low back pain.

The study was published in the August issue of Spine.

Funding for the research was provided by Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health grants and Agency for Healthcare Research and Quality.

Some of the authors receive benefits such as honoraria, gifts, consultancies, royalties, stocks and decision-making positions from a nondisclosed commercial party related to the subject material of the study.


Review Date: 
August 23, 2012