When it comes to diagnosing most back pain, MRI machines are like Monty Python’s medical machinery that goes “bing.” For back pain, MRI and X-ray are medical machines that make false alarms.
They don’t always make false alarms, of course. MRI is a miracle technology, no doubt about it — the ability to get clear images of soft tissues deep inside the body is valuable, and extremely tempting for everyone involved.12 MRI can shine when it’s actually needed and done well.
But the sad truth is that it’s not needed anywhere near as much as it is actually used, and it’s especially not needed for most low back pain. And not doing it “well”? That’s just normal: radiology reports are usually written without clinical context, and frequently presented to the patient like diagnoses. But low back pain experts have long understood that you simply cannot reliably diagnose low back pain with MRI or with X-ray in isolation3 — and trying to do so reliably raises false alarms that actually do harm.4 Premature MRI is actually often worse than useless.
Wise use of MRI is great (and I’ll finish with a summary of best practices). But the common overuse and abuse of MRI is a disaster of over-medicalization.
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