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The Lumbar MRI Paradox: Exploring Back Pain's Multifaceted Nature

Updated: Dec 23, 2023

MRI can identify a notable number of abnormalities in individuals who show no symptoms, implying that these findings should be considered normal or attributed to the natural ageing proces.

MRI paradox
MRI paradox


Back pain is an incredibly common ailment that plagues millions of individuals worldwide. While the use of magnetic resonance imaging (MRI) has become a valuable tool in understanding the causes of back pain, it's essential to recognize that the connection between lumbar MRI findings and back pain is not always straightforward.

Article 1: Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study (Kasch et al., 2022)

A study led by Richard Kasch and his team sought to examine the associations between lumbar degenerative changes seen on MRI and the presence of current or future low back pain (LBP). They gathered data from 3369 participants, representing a diverse population.

The study found that MRI findings were present in individuals with and without back pain at baseline. While most MRI findings were slightly more common in those with LBP, the difference in pain severity was minimal. Longitudinal analyses demonstrated that most MRI findings were not significantly associated with future LBP severity, whether participants had baseline pain or not. This study concludes that the MRI findings examined do not have clinically important associations with LBP, highlighting the complexity of the lumbar MRI-back pain relationship.

Article 2: Magnetic Resonance Imaging in Follow-up Assessment of Sciatica (El Barzouhi et al., 2013)

Sciatica is a condition often linked to lumbar-disk herniation, and MRI is a common tool used in its assessment. A study led by Abdelilah el Barzouhi focused on examining the association between MRI findings and clinical outcomes in patients with lumbar-disk herniation and persistent sciatica symptoms.

This study involved 283 patients, representing a sample of individuals who were experiencing this specific and often painful condition. After one year, 84% of patients reported a favourable outcome. What's remarkable is that the presence or absence of disk herniation on MRI did not significantly distinguish between patients with favourable or unfavourable outcomes. This suggests that MRI findings may not reliably predict clinical outcomes in patients with sciatica and lumbar-disk herniation, underlining the intricacies of the lumbar MRI-back pain relationship.

Article 3: Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations (Brinjikji et al., 2015)

Additionally, it's crucial to consider the prevalence of degenerative spine conditions in asymptomatic individuals. A systematic review led by W. Brinjikji and colleagues aimed to estimate the prevalence of these conditions in asymptomatic populations, drawing from a comprehensive analysis of existing research.

Their analysis included 33 articles that reported on imaging findings for 3110 asymptomatic individuals. This diverse and extensive data pool provided insights into the prevalence of various degenerative spine conditions. The study revealed that the prevalence of these conditions increased with age in asymptomatic individuals. Many of these degenerative features were present in high proportions of asymptomatic individuals, particularly as they aged. This suggests that these imaging findings are likely a part of normal ageing and may not necessarily be associated with pain, emphasizing the importance of a broader clinical context in assessing back pain.

The Complex Relationship Between MRI Findings and Back Pain

Collectively, these three studies underscore the intricate and multifaceted nature of the connection between lumbar MRI findings and back pain. They reveal that the mere presence of degenerative spine conditions on an MRI does not always explain the experience of back pain. Other factors, such as age, psychosocial elements, and individual pain perception, play crucial roles in determining a patient's pain experience.

As a result, a comprehensive approach is necessary when evaluating and managing back pain. Clinical assessments, including patient history, physical examinations, and consideration of the patient's overall health, are indispensable in making accurate diagnoses and treatment decisions. Over reliance on MRI findings may lead to unnecessary interventions and potential overtreatment.

The Key Takeaway

The key takeaway from these studies is that, while lumbar MRI is a valuable tool, it should not be the sole determinant of a patient's condition or the basis for treatment decisions. The intricate interplay of factors makes back pain a multifaceted issue that requires a holistic approach. By understanding the limitations of MRI and considering the broader clinical context, healthcare professionals can better guide patients towards effective pain management strategies. Back pain is not merely a picture on an MRI; it's a comprehensive narrative that needs to be unraveled through a combined effort of medical expertise and patient involvement.

Considering Holistic Approaches to Managing Back Pain

In the complex landscape of back pain, it's essential to recognize that MRI findings, while valuable, are not the sole determinant of an individual's condition. Rather, a comprehensive approach to assessing and managing back pain is paramount. In this context, exploring alternative therapies like osteopathy and acupuncture may hold promise.

Visiting an Osteopath

Osteopaths are healthcare professionals trained to diagnose and treat various musculoskeletal conditions, including back pain. They employ a holistic approach, considering how the body's structure and function are interconnected. Osteopathic treatments may involve manual techniques, such as joint manipulation, to alleviate pain and improve mobility. For some individuals, osteopathy provides a non-invasive and drug-free alternative for addressing back pain.

Acupuncture for Back Pain

Acupuncture is another alternative therapy with a long history of use in pain management. It involves the insertion of thin needles into specific points on the body to stimulate natural healing processes. Many people have found relief from back pain through acupuncture, as it may help reduce muscle tension and improve blood flow. Acupuncture is often considered as part of a holistic approach to pain management.


-Brinjikji, W., Luetmer, P.H., Comstock, B., Bresnahan, B.W., Chen, L.E., Deyo, R.A., Halabi, S., Turner, J.A., Avins, A.L., James, K., Wald, J.T., Kallmes, D.F. and Jarvik, J.G., 2015. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), pp.811–816.

-El Barzouhi, A., Vleggeert-Lankamp, C.L.A.M., Lycklama À Nijeholt, G.J., Van Der Kallen, B.F., Van Den Hout, W.B., Jacobs, W.C.H., Koes, B.W. and Peul, W.C., 2013. Magnetic Resonance Imaging in Follow-up Assessment of Sciatica. New England Journal of Medicine, 368(11), pp.999–1007.

-Kasch, R., Truthmann, J., Hancock, M.J., Maher, C.G., Otto, M., Nell, C., Reichwein, N., Bülow, R., Chenot, J.-F., Hofer, A., Wassilew, G. and Schmidt, C.O., 2022. Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Spine, 47(3), pp.201–211.


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