Is it useful to get a scan for my chronic back pain ?
With the pandemic making it increasingly difficult to access non-urgent services on the NHS, we have seen a definite increase in the number of patients seeking private and often self referred MRI scans for their back pain. Trouble is that, although the scan and report are provided, the translation of the radiological report isn't. In the past week I have found myself acting as translator for four worried back pain patients who have all presented to clinic clutching a CD -ROM in one hand and a report in the other hand filled with incomprehensible medical jargon which has terrified them and made them think the worst. I feel the same when the car mechanic attempts to tell me why my car is making that funny knocking noise !
Does all backpain need a scan ?
The short answer is, no. Of course there are are always going to be cases in which an urgent scan is necessary but thankfully these are few and far between and the vast majority of back pain can be managed very successfully by a clinician taking the time to take a good history and a careful examination without necessarily requiring a scan
. The problem with most imaging is that it only shows structure but NOT function or pain. Pain cannot be seen or measured on a scan and not all pain is a result of structural change. You see the dilemma.
However for many patients a scan is still sought as a means of excluding anything serious and getting a good picture of what is actually wrong. From my point of view as a clinician it can be helpful also and I do love it when my diagnosis is confirmed.
What scan is best ?
The four most regular types of imaging requested are listed below :
Xray
Ultrasound
CT
MRI
Each will play a different role and provide different views of the structures so choosing which one to order really is dictated by what structure needs to be looked at. Often your doctor or therapist can advise on this to ensure you get the best images for your particular problem. For example, Xray and CT both give clear, sharp views of bone whilst US gives a poor view of bone but is great for looking at soft tissue structures. Xray and CT both use radiation so shouldn't be done without good reason. In the majority of cases of back pain MRI reigns supreme as the scan of choice as it gives a good view of soft tissue, reasonable views of bone and doesn't use any radiation. Unfortunately it's popularity ( in all fields of medicine ) means it is often oversubscribed and difficult to access. Not to also mention that the machine itself can make many feel claustrophobic and those with pacemakers and some types on metalwork can't use it.
So when is a scan defintely needed ?
In relation to back pain an MRI scan is most urgently used when either there is the suspicion of damage to the spinal cord or the bones of the spine. This may be as a result of a trauma such as a fall or a car accident which is usually picked up pretty easily by the medical team in A & E. Sometimes a fracture may happen for a non-traumatic reason such as in someone with Osteoporosis ( thinning of the bones ) - these types of fractures ar eoften stable and don't threaten the stability of the spine but imaging will help to determine what treatent needs to be done.
Large disc prolapses ( slipped discs ) can occasionally cause problems with the spinal cord causing a condition called Caudae Equinae Syndrome ( CES ) which, whilst thankfully very rare, does need prompt medical attention. Any of the following symptoms should be investigated urgently :
Problems with bladder / bowel control
Altered sensation around the groin or between the legs
Loss of muscle power in one or both legs
Intense back pain / pressure
If you are unsure about your back pain and want to discuss your problem then why not book an appointment to see us for a full examination so we can give you an honest opinion about your back pain and the best way to go about treating it.