Many people believe when they have lower back pain that they need a scan (X-ray, CT, CAT or MRI) to find the cause but this is isn’t true. There are a few points we need to be aware of before we are quick to assume this is the next best step.
- PAIN DOES NOT MEAN DAMAGE
For most people, LBP isn’t clear but serious causes are very rare. More often than not, most cases will be better in approximately 4-6 weeks. Amongst 100 people with lower back pain the following results were found: approximately 90 people have no known cause for their lower back pain, 10 have nerve-related pain, which in many cases still do not require a scan and approximately less than 1 person has a serious cause and in some cases need a scan. Which brings us to our next point:
- SCANS RARELY CHANGE TREATMENT
A scan or result of a scan is unlikely to find a reason for your pain or change how it is treated. Typically all types of lower back pain are treated the same way to begin with. So even if a scan confirms the cause of your pain, it is unlikely to alter the management. More often than not, the words used in the report from the scan can be harmful to the patient.
As we age as a natural progression of life, seldom do question our wrinkles or grey hair. It needs to be normalized that just as our external body ages, internally with our bones there are also changes. The scans will show these natural age-related changes and may cause you to worry and lead to unnecessary procedures.
A study in 2015 by Turner, J et. Al. regarding the prevalence of spine degeneration on imaging in asymptomatic individuals was conducted on over 3,000 participants. The materials used for this was 33 studies that made the inclusion. The results were that all images in the reviews had an increasing prevalence with increasing age. Some of the findings such as disc degeneration and signal loss were present in nearly 90% of individuals 60yrs of age or older.
Another finding was that more than 50% of asymptomatic individuals 30-39 years of age have disc degeneration, height loss, bulging discs suggests that even in young adults, degeneration may be incidental and not causally related to presenting symptoms.
These findings can help reassure us that these changes are considered normal age-related changes rather than pathologic processes.