DEGENERATIVE OSTEOARTHRITIS AND THE RELATIONSHIP BETWEEN WHAT YOU SEE (OR DON'T SEE) ON X-RAYS OR MRI, TO PAINRead Now
DEGENERATION, PAIN, AND THE RELATIONSHIP BETWEEN WHAT SHOWS UP ON DIAGNOSTIC IMAGING (X-RAY / CT / MRI)
A few days ago, JAMA Internal Medicine (one of the many journals put out by the American Medical Association) published an article titled Low-Value Health Care Services in a Commercially Insured Population. It was filed under under the header, "Less is More". The letter began with the words, "More than $750 billion of US health care spending annually represents waste, including approximately $200 billion in overtreatment." Fortunately for you, if you've spent any time at all on my site, you already know about OVERDIAGNOSIS & OVERTREATMENT, particularly as it relates to things like ANNUAL PHYSICAL EXAMINATIONS or Advanced Imaging (MRI and CAT SCANS).
Two of the chief areas these "low value" imaging services are found are in the arena of headache and low back pain treatment. Let me give you a simple example of why these tests are considered low value. I see lots and lots of people for CHRONIC HEADACHES (including various sorts of MIGRAINES). The government says that headaches are one of the most common reasons for doctor visits. So, by the time I see them, most of this group has not only been to their doctor, they've frequently been run through all sorts of imaging; usually to rule out brain tumors. How common are brain tumors in the American population? According to the American Brain Tumor Association, "nearly 25,000 primary malignant" tumors are diagnosed each year. The word "primary" means that the tumor started in the brain (as opposed to secondary or 'metastatic' meaning it started somewhere else and then spread to the brain). This means that statistically, one in 12,800 Americans is going to have a primary brain tumor.
The other area that this letter specifically addressed was LOW BACK PAIN, which also has a significant portion of its imaging considered both unnecessary and low value. I'll let you in on a dirty little secret as to why this is true for both backs, necks, and heads (not to mention other areas of the body). There is little correlation --- many would argue no correlation --- between X-ray or MRI findings and a person's pain. This phenomenon is not uncommon elsewhere in the practice of medicine.
For instance, there is absolutely no relationship between heel pain (PLANTAR FASCIITIS) and the presence / absence of a heel spur. You are just as likely to see patients with no pain that have huge heel spurs, as you are to see patients with crippling pain and no heel spur. Likewise, study after study shows that when it comes to WHIPLASH and other injuries sustained in MVA's, there is no relationship between the damage to the vehicle and the amount of injury sustained by occupants. The number one sports surgeon in America, Dr. James Andrews, said the same thing about shoulder problems (HERE). Not surprisingly, we see an almost identical scenario with both back and neck pain.
Follow along as I present you with some 'cherry-picked' tidbits, and you'll see why my brother, an ER physician with many many years of experience (his wife is also an ER doc), says that doing an MRI of your spine or skeleton is a waste of time until you are actually to the point of being ready and willing to have surgery. Why? Because, he says, doctors can always find something that looks bad enough to do surgery on. Here's why this approach has left so many POST-SURGICAL PATIENTS no better, or even worse, than before the operation. Which becomes that much more interesting in light of the post I did on ASYMPTOMATIC DISC HERNIATIONS a few years ago.
All of this is why, about three years ago, I stopped taking X-rays in my clinic after over two decades of doing so. It was all but totally impossible to correlate patient complaints to what I saw on their films. It was very easy for me to say, "There's your problem Mrs. Jones. It's those nasty bone spurs, calcium build up, and thin discs. Your problem is that your spine is simply wearing out." But the next person that came in might have even worse degeneration --- sometimes so severe you wondered how they were ambulatory --- but never really had pain until recently. Or they may have had severe pain with a "normal" looking x-ray. There was no rhyme nor reason. I just found a viable explanation for this phenomenon.
DEGENERATIVE ARTHRITIS (OSTEOARTHRITIS)
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).