Medicine has somehow managed to create a culture around low back pain. Maybe it was unintentional. Maybe it was ignorance. Maybe it was willfully done to support the “system.” Whatever the reason, it costs society massive amounts of money on waste.
Usually not a month goes by when some patient is told by their PCP that they should stop seeing a chiropractor (sometimes after only 1 or 2 visits) and see a PT or get an MRI or both. Worse, there are many times that a chiropractor does not even become a part of the equation. The costs when a chiropractor is NOT involved skyrocket. Here in AZ, a patient seeing their PCP first may end up costing some 30% more. If they manage to self refer to a PT, the costs are almost TRIPLE.
The reasons for this are multiple, but the bottom line is that we are experts at low back pain and are very good at controlling care. This means that we infrequently order X-rays and rarely order MRIs. I know that, in our office, if the patient’s low back pain and leg pain looks an awful lot like sciatica from a disc bulge, why the heck would I order an MRI if I already have a very good idea of what is going on?
This particular study has some interesting findings. Researchers looked at patients getting an epidural for low back pain with leg pain (lumbosacral radiculopathy) and whether or not they actually needed an MRI before the procedure. What??? Of course you need an MRI before someone sticks a very long needle into the most sacred of regions in your spine!! Or do you..
Here are the findings when comparing 2 groups of patients, one group where the MRI was used to guide the epidural procedure and a second group where the MRI was NOT used:
- Slightly less leg pain in the MRI group at 1 month
- No differences in pain or function at 3 months
- After 3 months, only 35% in group 1 and 41% in group 2 showed improvement
- In non-MRI patients who received a different injection than that proposed by an independent physician (basically a 2nd opinion, but this doctor did actually look at an MRI of the patient), the outcomes were not quite as good as those whose procedure matched that the MRI findings
- Collectively, 6.8% of patients did not (group 2) or would not have (group 1) received an epidural after the MRI was reviewed
So, the bottom line is that MRI made very little difference in the outcomes of the epidural. Further, a little under 2/3 of the patients received no long term benefit from the whole process. All for the price tag of around $10K. Give a good chiropractor $10K to work with and we’ll have the vast majority of patients competing for the Ironman Triathlon in 6 months….