Does MRI Predict Back Pain?

Many people assume that getting an X-ray or MRI scan will show them why their back is hurting. But is this actually the case?

Actually there's more evidence that having an X-ray or MRI scan can make your outcome worse, especially if it's done within the first 3 months of the pain starting.

A recently published study of low back pain patients found that early disc degeneration seen on an MRI scan did NOT predict future pain or disability at a 30 year follow up.

However there are times when having a scan sooner rather than later is essential. These are when the red flags of back pain are present, which increases the risk of having a more serious injury or condition that requires medical intervention.

TUNA FISH is an acronym for these red flags.

If you get a new back pain, have persistent pain or pain that isn't getting better AND you have one or more of these red flags you should discuss with your doctor about having a MRI scan or X_ray sooner rather than later to determine if there's a more serious injury or condition that requires medical intervention.

Rest assured that these red flags are rare, and most cases of back pain are relatively benign. 

So, if you don't have any of these red flags present should you get an X-ray or MRI scan of your spine done?

Let's look at a study published in 2020 that looked at disc degeneration in low back pain patients and followed them up 30 years later to see whether they were still in pain or not.

In 1987, 75 low back pain patients had lumbar spine MRIs. They were all young military recruits whose back pain was severe enough to prevent them from serving. 

30 years later the subjects were contacted, 35 completed a pain and disability questionnaire,. 26 of these 35 were re-examined clinically and had a MRI scan.

What did they find when they followed up with these patients 30 years later?

• The number of discs showing degeneration increased from a mean of 0.9 to 3.5 per subject.
• Discs that showed signs of early degeneration had progressed to severe degeneration on the 30 year follow up MRI scan
• There was NO significant association between the severity of disc degeneration and pain or disability.

What can we take away from this study?

Firstly, the caveats are that this was a small study and only about half of the original subjects took part in the follow up. Also the researchers didn't have the original MRI scans, only certain values that denote disc degeneration.

What we can conclude from this study is that MRI scans do pick up early signs of disc degeneration, and this is associated with severe changes but NOT pain or disability over time.

This study adds to a large and growing body of evidence showing that low back pain doesn't just occur because of structural changes or damage to the spine. In fact, changes seen on diagnostic images have an extremely weak correlation with the amount of pain felt by the person.

Another 2020 study conducted at the University of Gondar comprehensive specialized hospital, North West Ethiopia in 2020 backs this up.

In the Ethiopian study 72 patients with degenerative disc disease completed a pain and disability questionnaire and had a lumbar spine MRI scan. They were aged from 22 - 83 years, with an average of 43 years. 

The MRI scans showed these to be the most common findings:

1. Disc bulge 81.9%
2. Foraminal stenosis 65.3%
3. Disc dessiccation 54.2%
4. Disc herniation 41.7%
5. Spinal canal stenosis 41.7%

Almost half of the patients reported minimal pain or disability, with only 3.9% having severe pain. 

This study shows that there are a wide variety of spinal changes commonly seen on MRI scans, but these changes aren't associated with the level of pain or disability felt by the person.

So why aren't MRI scans good at predicting back pain?

Well, the scan is designed to pick up structural changes. MRI scans are very sensitive and can detect even small changes.

But, the scan doesn't tell you WHAT'S driving the pain or WHY you're feeling pain.

All the X-ray or MRI scan image can tell you is that there's a change to the anatomy of your spine. It can't determine whether that change is going to cause you a problem or not.

Pain, especially chronic pain, is complex and can be driven by many factors, including core beliefs, lifestyle, stress levels, sleep quality etc. These biopsychosocial factors affect the nervous system, cell health and, therefore, muscle behaviour, which aren't visible on scans.

Should you get an X-ray or MRI scan done if you have back pain?

As with most things there isn't a black or white, yes or no answer!

If you have any of the red flags - TUNA FISH - present you should definitely consult with your doctor about having a scan to rule out anything serious that require medical intervention. Fortunately these are rare.

Most cases of back pain fall into the category of benign, even though they may be debilitating and frustratingly slow to resolve.

There's a large body of evidence showing that MRI scans routinely detect structural changes to the spine, but many people of all ages have these without pain or clinical symptoms. Many studies have concluded that the correlation between MRI findings and the amount of pain or disability experienced by the person us extremely weak.

Other studies show that having an MRI scan actually worsens a person's outcome in recovering from back pain. This is a phenomenon called catastrophising It's a big subject in It's own right, and warrants a whole new blog!

Study Links

• Sääksjärvi S, Kerttula L, Luoma K, Paajanen H, Waris E. Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study. Spine (Phila Pa 1976). 2020 Oct 1;45(19):1341-1347. doi: 10.1097/BRS.0000000000003548. PMID: 32453239. https://pubmed.ncbi.nlm.nih.gov/32453239/
• Gebrewold, Y., Tesfaye, B. Does lumbar MRI predict degree of disability in patients with degenerative disc disease? A prospective cross-sectional study at University of Gondar comprehensive specialized hospital, North West Ethiopia, 2020. BMC Med Imaging 22, 138 (2022). https://doi.org/10.1186/s12880-022-00866-7 

NEXT STEPS

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• Join "The Back Pain Relief" course HERE - a self paced, online course which will show you how to safely manage your back pain so you can confidently get on with your day and enjoy your favourite activities without the fear or frustration of hurting your back again. You'll get a simple back care maintenance programme that's easy to slot into your daily routine. 
• Book into a Stretch, Yoga or Pilates class with me - become a student of your body to begin the process of self healing
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