Tests – what are they good for?
In the realm of back pain tests, of
MRIs that question must be questioned. What are MRIs good
for when the proportion
of constructive, influential MRI studies is so small?
False positive MRI results trouble those who receive
such results. They arouse fear or caution where it
is not always needed. MRIs like this confuse the
proper treatment plan. They spend a lot of money.
Palmer Chiropractic Center carefully evaluates the necessity of
MRI in the Lynchburg chiropractic treatment plan of Lynchburg
back pain relief.
MEDICINE’S VIEW
Interpretations of MRI images by
radiologists often vary.
The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1)
MRI imaging may trigger false suspicion. When
following the guidelines of the American College of Radiology, 93% of lumbar
spine MRIs were appropriate. Of those, only 13% found
anything suspicious. Of the 36 MRIs that raised
suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up
MRIs on those suspicious findings were false positives. (2) MRI imaging may misinform.
For example, MRI demonstrates that the appearance of
disc degeneration in asymptomatic persons – persons with no back pain – rises
with age: 37% in 20 year olds and 96% in
80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular
fissures 19% to 29%. These imaging findings imply that
these are signs of normal aging. They remind all doctors, remind chiropractors
like yours at Palmer Chiropractic Center, to correlate all such
findings with patient symptoms. (1,3) Your Lynchburg
chiropractor does this!
CHIROPRACTIC’S VIEW
Choosing Wisely guidelines for American chiropractors recommend
not repeating spinal imaging and not getting spinal imaging for
patients with acute low back pain in the first 6 weeks of back pain (except when “red flags” are present– issues that indicate
something more disturbing). (4) A review of the effectiveness
of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal
pain and symptoms reported that there is very low risk of missing
a worrying cause of back pain. (5) The goal
of guidelines is less imaging, fewer false positives. Palmer Chiropractic Center wants what is
best for our Lynchburg chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Palmer Chiropractic Center review
all the symptoms, tests and images our Lynchburg chiropractic back
pain patients [[present on|bring with them39] their first Lynchburg
chiropractic visit. So many back pain patients present to
Palmer Chiropractic Center with MRI images already done.
Palmer Chiropractic Center will look at them but will depend more
on clinical exam findings and correlate them to what the MRI reveals.
A rule of thumb with the Cox Technic System of Back Pain Relief is to work
toward 50% decrease of back pain in the first 30 days
of care before arranging additional imaging or
testing or referring for surgical consultation. (6)
CONTACT Palmer Chiropractic Center
Listen to this PODCAST
with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he explains
the role of imaging for back pain in the program of treatment
for pain relief.
Schedule your Lynchburg chiropractic appointment
with Palmer Chiropractic Center today. Let’s explore together
the best path to Lynchburg back pain relief – with or without MRI
imaging!