The Overuse of MRI for LBP Patients

With the increase in pain found in everyday patients it can be difficult to determine if that specific pain requires testing. Doctors in Quebec's hospitals currently hope to find a solution to the overuse of magnetic resonance imaging, MRI, for lower back pain by trusting in the same technology that other parts of Canada as well as the United States have adopted.

Representatives from the Center Hospital University de Sherbrooke, CHUS, have recently provided data at the annual American College of Rheumatology meeting and proved that more than half of patients with low back pain and have neurological symptoms are known to undergo routine MRI scans.

The American Board of Internal Medicine's new public guidelines indicate that MRI should only be given to those with low back pain who have intense pain or motor symptoms. Based on this new dogma, the “Choosing Wisely” guidelines can induce conversation with clinics and patients by giving patients the ability to choose who they want to care for them and ensure that they will not be tested for the same things they were already tested for. Unfortunately for Quebec, the Choosing Wisely approach has not been widely adopted, but here in the US it has become quite a thing. Many areas have decided to use these and have integrated it into their health systems.

Experts speak of a form for physicians to fill out when they want to request an MRI for a patient. They are also training a large number of physical therapists to screen patients and determine if they need a referral to their spine clinic to increase the rate of spine specialist consultations.

From there they will begin to refer to the radiology department for the same screening. This will help the hospital provide the proper care for the patient and help the patient receive the most accurate care needed. This will also allow the patient and health care providers to educate themselves and support their required needs.

It can also provide more acceptable use of MRIs and other services. One doctor has stated that the previous way of providing MRIs does not work and that at least this way they can provide a more interactive and direct process for referring physicians and radiologists. This also provides an accountability process, including more interaction between other doctors and doctors with patients.

With the introduction of this new method, the numbers of spine imaging has diminished by about 33 percent. This study was one of the first to be done in Quebec and to really look at the need of MRI for lumbar spine pain. Doctors have been able to review more than 400 lumbar spine MRI scans that were done on people with low back pain and neurologic symptoms from the beginning of 2005 to the end of 2007. The majority of these patients with this issue and given MRIs were on average 52 years old with 55 percent of them begin men. In all more than 45 percent of the MRI scans that are clinically concordant neurologic compression.

Surprisingly, spine specialists were not the ones with the highest rate of MRI orders. All in all, one out of four patients who have had a spine MRI scan have likewise had a spine injection or some sort of spinal surgery. Over time this rate increased to 42 percent with patients that had an MRI done with nerve compression. Experts have done other studies like this for those who were given knee MRIs and found that only a small percent of patients have to get invasive procedures. 

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