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MRI for back pain: more harm than good?

If you head to the doctor with low back pain, you may be sent for magnetic resonance imaging to look for spinal abnormalities that could be triggering your discomfort. But the American College of Physicians and other physician groups have launched a campaign to end routine imaging for low back pain because there’s no evidence of any benefit and it often leads to more invasive testing and unnecessary treatments such as surgery.

With the exception of emergency situations such as a serious injury or suspected tumor, MRI scans “don’t change where patients with low back pain will be in a year in terms of whether their pain will become chronic or will go away on its own,” said Dr. Steve Atlas, a primary care internist at Massachusetts General Hospital.

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But the scans will find spine abnormalities in most adults, even those who are free of back pain. Many have bulging disks, and about two-thirds of those in their 40s have signs that their disks are wearing from age and arthritis, a condition that may be diagnosed as degenerative disk disease. “Pretty much everyone over 60 has it,” said Atlas.

If back pain persists unabated for more than six weeks, an MRI scan may be warranted.

“I try not to order one if I don’t think it will change what I’m doing for a patient,” said Dr. Frederick Mansfield, an orthopedic spine surgeon at Massachusetts General Hospital.

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