Spinal degeneration found on MRI not linked to the severity of future back pain
Three pages on PainSci cite Kasch 2022: 1. The Complete Guide to Low Back Pain 2. The Double-Edged Sword of Imaging to Diagnose Pain 3. Back pain doesn’t follow the signs
PainSci commentary on Kasch 2022: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused 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 wherever possible.
This is a large study of the relationship between back pain and common signs of spinal arthritis, finding mostly that … there wasn’t much of one. The correlation was there, it was just rather puny. MRI findings, on average, “do not have clinically important associations with low back pain.”
The study was a bit unusual and quite useful because it was a big “longitudinal” one: observing the same group of people for a long time. We don’t see a lot of those in back pain research, especially of this size/duration: about 3300 people studied for over six years. That design gives us insight into the order of things, producing what I think is the most important single result here: pain didn’t develop in people who started out with signs of spinal degeneration. It’s not just that signs and pain aren’t strongly correlated, it’s that pain doesn’t follow the signs. More formally stated by the authors:
“We found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain.”
And the signs don’t follow the pain either!
Another way to sum this study up: most spinal arthritis isn’t painful, which sounds a bit radical. But none of this is actually news. It’s just excellent new data that really drives the old point home that most back pain is not really about spines being all cruddy with arthritis.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
STUDY DESIGN: Population-based cohort study.
OBJECTIVE: We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP).
SUMMARY OF BACKGROUND DATA: The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse.
METHODS: Participants (n = 3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain.
RESULTS: MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6 years in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38).
CONCLUSION: Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale. Level of Evidence: 3.
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