Meeting News

MRIs not always necessary for low back pain

Kenrick Duru
Obidiugwu Kenrick Duru

PHILADELPHIA — More than 90% of patients would not benefit from an MRI early in their treatment for low back pain, according to a speaker at the American College of Physicians Internal Medicine meeting.

“A study showed 93% of patients who got an early-stage MRI for low back pain received little useful information,” Obidiugwu Kenrik Duru, MD, MSHS, professor of the department of medicine, David Geffen School of Medicine at the University of California Los Angeles, told attendees.

This is likely due to an MRI only showing a limited part of the low back pain picture, he said.

“Biomechanical factors are only one factor that makes up low back pain. The condition is also caused by medical comorbidities, genetic factors, psychological factors like depression and anxiety, work history, and socioeconomic status,” Duru said.

He provided tips on identifying the 7% of patients that could benefit from an MRI within 6 to 8 weeks from the start of the back pain.

“Look for red flags, such as the possibility of cancer, a compression fracture or an infection at the back of the spine, or a herniated disc that is severe enough that it is causing bladder complications or other long-term consequences. Taking a patient’s medical history that asks about these conditions as well as well as IV drug use and tuberculosis should help identify most of these red flags,” he added.

MRI 
More than 90% of patients would not benefit from an MRI early in their treatment for low back pain, according to a speaker at the American College of Physicians Internal Medicine meeting.
Source:Shutterstock

Duru pointed out some of the potential harms MRIs can have on both patients and clinical practice as he discussed his presentation with Healio Primary Care Today.

“You or the patient may see something on an MRI that makes you or the patient think that is the cause of the back pain and that surgery must occur. However, if the spot on the MRI has shown up on a previous MRI or anatomically lines up with the source of the patient’s pain, the surgery is not likely to be beneficial,” Duru said.

“Performing frequent MRIs is also not a cost-effective way to run a health system. Chances are what you see on the MRI was there before the patient first felt the back pain. They rarely add new information, and do not help us guide treatment, so we should only do the MRI if we think it is going to make a significant difference, but in most instances that is not the case,” he continued.

Duru shared a personal approach for handling those who are still stubbornly against anything but an MRI.

“There was a study where 200 patients with no back pain had MRIs and then were followed for the next 5 years. As these patients said they had new instances of back pain, they would get another MRI. But in 88% of these instances, the baseline MRI and the follow-up MRIs were identical,” Duru said in the interview. “Sharing that study’s results usually settles the debate.” – by Janel Miller

Reference:

Duru OK. “Back pain: Get your patient back in the game.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.

Disclosures: Duru reports no relevant financial disclosures.

Kenrick Duru
Obidiugwu Kenrick Duru

PHILADELPHIA — More than 90% of patients would not benefit from an MRI early in their treatment for low back pain, according to a speaker at the American College of Physicians Internal Medicine meeting.

“A study showed 93% of patients who got an early-stage MRI for low back pain received little useful information,” Obidiugwu Kenrik Duru, MD, MSHS, professor of the department of medicine, David Geffen School of Medicine at the University of California Los Angeles, told attendees.

This is likely due to an MRI only showing a limited part of the low back pain picture, he said.

“Biomechanical factors are only one factor that makes up low back pain. The condition is also caused by medical comorbidities, genetic factors, psychological factors like depression and anxiety, work history, and socioeconomic status,” Duru said.

He provided tips on identifying the 7% of patients that could benefit from an MRI within 6 to 8 weeks from the start of the back pain.

“Look for red flags, such as the possibility of cancer, a compression fracture or an infection at the back of the spine, or a herniated disc that is severe enough that it is causing bladder complications or other long-term consequences. Taking a patient’s medical history that asks about these conditions as well as well as IV drug use and tuberculosis should help identify most of these red flags,” he added.

MRI 
More than 90% of patients would not benefit from an MRI early in their treatment for low back pain, according to a speaker at the American College of Physicians Internal Medicine meeting.
Source:Shutterstock

Duru pointed out some of the potential harms MRIs can have on both patients and clinical practice as he discussed his presentation with Healio Primary Care Today.

“You or the patient may see something on an MRI that makes you or the patient think that is the cause of the back pain and that surgery must occur. However, if the spot on the MRI has shown up on a previous MRI or anatomically lines up with the source of the patient’s pain, the surgery is not likely to be beneficial,” Duru said.

“Performing frequent MRIs is also not a cost-effective way to run a health system. Chances are what you see on the MRI was there before the patient first felt the back pain. They rarely add new information, and do not help us guide treatment, so we should only do the MRI if we think it is going to make a significant difference, but in most instances that is not the case,” he continued.

Duru shared a personal approach for handling those who are still stubbornly against anything but an MRI.

“There was a study where 200 patients with no back pain had MRIs and then were followed for the next 5 years. As these patients said they had new instances of back pain, they would get another MRI. But in 88% of these instances, the baseline MRI and the follow-up MRIs were identical,” Duru said in the interview. “Sharing that study’s results usually settles the debate.” – by Janel Miller

Reference:

Duru OK. “Back pain: Get your patient back in the game.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.

Disclosures: Duru reports no relevant financial disclosures.

    See more from American College of Physicians Internal Medicine Meeting