This episode is entitled “Why you shouldn’t have an MRI for sciatica”, and the main reasons covered are:
- More pain and disability
- More cost
- Red herrings in MRI for sciatica
- When should you have an MRI for sciatica
More pain and disability
If you have an MRI, you tend to end up with longer term pain and more disability than if you don’t have an MRI. If we take a hundred people with identical identical lower back issues and symptoms and split them into two groups -one that doesn’t have an MRI and one that does-, in the long run, the group that has the MRIs ir more likely to get more pain and disability.
People who have MRIs not only has to pay the cost of the MRI itself, but also a lot more interventions, like injections, surgery, medication. All sorts of costs go up. That may not be surprising, but these are people with the same problems as the people who don’t have the MRI. In fact, in the US the cost of having an MRI for a lower back / sciatica problem is about $13,000 higher than people who don’t have the MRI. And the MRI only makes up part of that cost.
This is probably what leads to more pain and more costs. When you have an MRI after the age of 10 or 15 years old, they will likely find some abnormalities, things that aren’t quite perfect on your MRI. Yet, these are not really abnormalities for many of us. These are totally normal changes that come with time. The idea that your lower back would look like an anatomy textbook is just naive. Those are drawn to show perfect anatomy, which we don’t have. Even at birth we have these so-called abnormalities. But finding them as we age only heightens people’s anxiety.
Some radiologists are very good at demystifying and downgrading the so-called abnormalities and will calm you down. Unfortunately, that isn’t the way the conversation often goes. It’s usually a bit more rushed. If you’re set off on the wrong track and you believe things can’t get any better, they won’t. So don’t worry about it.
Red herrings in MRI for sciatica
If you have an MRI, it will show something that isn’t perfect. But there’s a good chance that isn’t the cause of your pain. There’s very little correlation between what we see on an MRI and the symptoms someone has or how they feel, especially when it comes to degenerative changes. A lot of studies show that for two men, one of them will have disc bulges, social prolapses herniations in their lumbar spine, but that is a 40 year old men with no symptoms. These are people who have not had lower back pain / sciatica. Yet they have disc bulges and prolapses. The incidence or frequency of that goes up with age. MRIs through operative hearings, and you then often end up in a situation where your clinicians are treating the MRI instead of treating you.
When should you have an MRI for sciatica
If you answer yes to more than one of our red flag / safety questions, you should have further investigation. It might not be an MRI, but you should consult a clinician who specializes in lower back / sciatica problems. You can find those questions on our website backpainandsciatica.co.uk, which is very much focused on self-help. There’s an offer of a free assessment. Click on the link and a chat bot -programmed by me- will open up. We’ll ask you these questions, and if you answer yes to any of them, you should consult a clinician with a view to perhaps ultimately having an MRI. It doesn’t mean you need one, but you might.
If you’d like a free online assessment of lower back pain / sciatica, click the link.