Back pain not cause by a narrowed spinal canal alone
PainSci summary of Haig 2006?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focussed on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★★?5-star ratings are for sentinel studies, excellent experiments with meaningful results. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
In this study, about 150 people were assessed for back pain in different ways, including MRI, but “radiologic and clinical impression had no relation.” In other words, there was no useful similarity between evaluation of the patient with MRI, and evaluation by examination and taking a history. “The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain.” Since MRI does in fact identify narrowing of the spinal canal, and this is the whole basis of diagnosing spinal stenosis with MRI, these results also strongly imply that a narrowed spinal canal does not (alone) cause back pain.
OBJECTIVE: To assess the relations between clinically recognized lumbar spinal stenosis and the conclusions of masked radiologists and electrodiagnosticians.
DESIGN: Prospective, masked, double-controlled trial.
SETTING: University spine center.
PARTICIPANTS: One hundred fifty persons age 55 to 80 years with or without back pain and with or without magnetic resonance imaging (MRI)-demonstrated stenosis, screened for neuropathy risk, previous surgery, or cancer.
INTERVENTIONS: Questionnaires on pain and function; ambulation testing and physical examination; and masked electrodiagnotics and MRI.
MAIN OUTCOME MEASURE: Diagnostic impressions of the examining clinician, radiologist, and electrodiagnostician.
RESULTS: Following application of post hoc exclusion criteria and elimination of patients due to incomplete or inadequate test data, the clinical diagnosis was lumbar stenosis in 50 subjects, back pain in 44 subjects, and no pain in 32 subjects. Radiologic and clinical impression had no relation (P = .80 vs asymptomatic, P = .99 vs back pain controls). Electrodiagnostic impression trended to relate to clinical impression (P = .14 vs asymptomatic, P = .09 vs back pain). Retrospective application of age-related electrodiagnostic norms for paraspinal electromyographic and limb motor unit changes, established in this study, reclassified 13 of the 17 asymptomatic persons whom the electrodiagnostician thought had stenosis. The clinical impression did correspond to history and physical examination findings typically associated with spinal stenosis and to the independent impression of a neurosurgeon who examined MRI and clinical, but not to the electrodiagnostic data.
CONCLUSIONS: The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain. Electrodiagnostic consultation may be useful, especially if age-related norms obtained in this study are applied.
These three articles on PainScience.com cite Haig 2006 as a source:
- PS Save Yourself from Low Back Pain! — Low back pain myths debunked and all your treatment options reviewed
- PS Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain
- PS MRI and X-Ray Often Worse than Useless for Back Pain — Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms