Does your MRI really mean you need surgery?

It should be understood that pain is not recorded on an MRI. Just because an abnormality is seen on the MRI pictures, it may or may not be related to the patient’s painful back or joint condition.

by Dr. Fred Arnold — 

Far too often, a patient will say a doctor has recommended surgery for a painful back or joint condition based on a magnetic resonance imaging (MRI) test. This diagnostic test can visualize the internal structures of the body and be an invaluable tool to identify abnormalities in an area where the pictures are taken.

It should be understood that pain is not recorded on an MRI. Just because an abnormality is seen on the MRI pictures, it may or may not be related to the patient’s painful back or joint condition. One example is disc abnormalities that occur in the low back. The disc acts as a shock absorber between the bones in our low back (vertebrae) and frequently shows abnormalities on MRI studies.

Tears in the disc are typically discovered on MRIs, yet several studies found no correlation between the presence of these tears and back pain. A bulging disc is another disc abnormality seen on MRIs, yet more than 50 percent of people without back pain have bulging discs. A problem arises when the MRI is used to determine the necessity of back or joint surgery without taking other factors into consideration.

Some of the other factors that need to be considered include the following:

Physical examination

To properly evaluate a painful condition, a physical exam of the involved area should always be performed. If a person is having pain in the back or painful joints, different orthopedic tests can be performed. A few years ago, while I was examining a patient’s painful shoulder, I realized he was looking at me in a startled manner. When I asked if everything was all right, he said he had seen three orthopedic doctors, each of whom recommended surgery, and I was the first doctor to actually touch his shoulder.

Referred pain

Referred pain is pain perceived at one location of the body that is actually coming from a different area of the body. An example is the case of decreased blood flow brought on by a myocardial heart attack, where pain is often felt in the neck, shoulders and back, rather than in the chest, the site of the injury. I have found patients with hip pain that actually originates from their low back, despite what is revealed on an MRI.

Biomechanic and energetic relationships

Each part of the musculoskeletal system works in tandem and is affected by other parts of the body. It is not uncommon when I examine a painful knee to find an involved pelvis, ankle, foot or short leg on the side of the painful knee. A patient recently told me that his chronic, post-surgical low back pain was 90 percent improved when he started wearing orthotics to support his feet. Biomechanics of the involved area should always be taken into consideration when surgery is recommended.

Before surgery for a painful back or joint is considered, energetic relationships to the painful area should be taken into consideration. Neural therapy is an injection therapy that focuses on energetic relationships in the body and the relief of chronic pain and long-term illness. Injecting local anesthetics into scars, acupuncture points and points along peripheral nerves is a treatment to relieve painful back and joints. I recently injected a surgical scar on a patient’s jaw area and she felt an immediate improvement in her ability to swallow.

Osteoarthritis

Osteoarthritis is one of the most common conditions that can affect us as we age. It is a wear and tear of the joints of the body, and it should be noted that most osteoarthritis does not cause pain; otherwise the majority of people older than 40 years of age would have pain throughout their bodies. If osteoarthritis is found at the suspected joint and pain is not present on examination of that joint, further consideration of other areas should be explored.

Exploring all treatment options 

Many patients have been told that they have few options to deal with their painful back or joint problem, such as prescription medications, steroid injections (including epidurals) and physical therapy. If the patient is still in pain after these limited options have been exhausted, he may be told nothing else can be done except surgery or to “just live with the pain.”

It is rare that patients are advised to explore other options, such as acupuncture or regenerative therapies like prolotherapy, prolozone or platelet rich plasma (PRP).  I am currently treating a 78-year-old man with severe degeneration of his hip joint. Surgery had been recommended, but he decided to explore other options since both his wife and father died from complications related to their hip surgeries. After five prolozone treatments, he reported a 70 percent improvement in his pain. Until these other treatment options have been discussed on an individual basis with each patient, I believe surgery should be avoided for back and joint problems.

Summary

Most of the patients I see have been previously seen by three to five other doctors. Many were told they needed surgery, based on their painful back and joint pain and associated MRI findings. I am not opposed to surgery when it is medically necessary to relieve the patient’s presenting condition; however, I am opposed to surgery when the patient has not been properly evaluated with a thorough physical examination and all of the above considerations have not been explored. I encourage each person to be proactive with personal health and consider surgery for painful back or joint conditions as the last option.

References

1. Jarvik, J.G., Hollingworth, W., Heagerty, P.J., Haynor, D.R., Boyko, E.J., Deyo, R.A. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine (Phila Pa 1976). 2005;30(13):1541.

2. Arendt-Nielsen, L., Svensson, P. (2001). Referred muscle pain: basic and clinical findings. Clin J Pain 17(1):11-9.

Fred G. Arnold, D.C., N.M.D., has more than 20 years of clinical experience and specializes in pain rehabilitation services. He is a Diplomate of the American Academy of Health Care Providers, Fellow of American Academy of Ozonotherapy, member of American Academy of Pain Management and is one of the few physicians in the nation with both a naturopathic medical degree and chiropractic degree. 602-292-2978 or prolotherapyphoenix.com.

Reprinted from AzNetNews, Volume 33, Number 1, February/March 2014.