Dr. Jacqueline Gerhart: Don't Just Live With Low Back Pain
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I have had bad low back pain for three years. I've read that X-rays won't show anything and that I need an MRI. Is there a way to get an MRI ordered without having to visit my primary doctor or a specialist?
Dear Reader: I'm sorry to hear you have chronic low back pain. Unfortunately, you aren't alone. A 2010 study published in the Journal of Pain showed that of 30,000 American adults, 31 percent reported they have chronic pain, and 8 percent stated they have chronic low back pain. And the prevalence of low back pain is rising. In a study from the Archives of Internal Medicine, the prevalence of low back pain increased from 3 percent in 1992 to 10 percent in 2006.
In primary care offices, we see at least one patient with low back pain per week on average. Many other patients will mention that they have chronic low back pain - even if that isn't the reason for their visit. It seems that some patients "just live with it."
The bottom line is, you shouldn't need to "just live with it." However, an MRI is not the only way to find out what is wrong with your back. And there is no guarantee that a positive finding on your MRI actually will be the cause of your back pain.
Trust me, just like anyone, I want to point at something and say, "There, see that? That's what's wrong with you. Now let's fix it." But, in reality, 85 percent of all back pain is actually "non-specific back pain." In these 85 percent of cases, an MRI often is not helpful. Non-specific back pain includes things like low back strains and sprains, sciatic pain and referred pain from other non-spine issues. Specific back pain - that we may see on imaging - includes fractures and herniated disks.
There are three main reasons you should see your physician for your back pain before getting imaging:
- No imaging test can replace a complete history and physical. Hearing how the injury developed and doing specific movement, strength and sensation tests in the office can very quickly rule in or rule out "red flag" problems like a fracture, a slipped/herniated disk or spinal cord compression. For example, a "straight leg test" can indicate a herniated disk, and reflex testing can help pinpoint if a nerve root may be involved.
- Imaging can be misleading because many asymptomatic patients will have findings on an MRI, and those with symptoms may have little or no findings on an MRI. Also, there is no evidence that getting an MRI improves the person's low back pain in the long run. In other words, in the absence of "red flag symptoms," we likely can determine the best course of treatment or action, even without imaging.
- There are often other co-contributors to low back pain. Depression, sleep problems, unemployment or work concerns can all contribute to the presence, duration and severity of one's low back pain. Sometimes treating underlying issues or helping with coping strategies, workplace modifications and increasing physical activity are the best answers for improving back pain. And, these strategies - along with medication and physical therapy - may be all you need.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 10/16/2013