The Australian Physiotherapy Association (APA) has refuted claims made in a recent article that suggests improved MRI scanning will support better diagnosis and treatment of complex back pain, a condition that affects 3.7 million Australians.
The article, that suggests back pain can be correctly diagnosed and treated by using a new MRI scanning technique, unfortunately fails to recognise that the difficulties diagnosing and treating back pain are rarely due to inadequate imaging technology, but rather because of the complexity of pain and the poor correlation between pain and tissue damage.
Back pain experts have long understood that you simply cannot reliably diagnose low back pain with MRI in isolation — and trying to do so reliably raises false alarms that actually do harm. Premature MRI is actually often worse than useless.
Even people with no pain find all kinds of things “wrong” with their backs if given an MRI, and the problem is that once we believe that we have a significant problem, then psychologically it becomes very difficult to get rid of this fear and pain. Research has demonstrated that by the age of 50, over 80% of people with no pain will have disc degeneration visible on MRI, and by the time we are 70, this goes up to 93%. Over 75% of pain-free 70 year olds will have disc bulges found when given an MRI. Just because we have these things visible on MRI, doesn’t mean that we have a problem or a reason to have pain.
As APA National Chair of Pain group, Dianne Wilson puts it, the “crucial aspect in treating chronic pain is to identify people’s beliefs about their pain in their own context and educate them about the body’s ability to adapt and heal given the right environment. This is best achieved in a multi-disciplinary team where focused exercise and education is delivered by qualified health practitioners such as physios”.