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Spinal degeneration found on MRI not linked to the severity of future back pain

PainSci » bibliography » Kasch et al 2022
Tags: etiology, back pain, arthritis, intervertebral disc, spine, pro, pain problems, aging

One article on PainSci cites Kasch 2022: The Double-Edged Sword of Imaging to Diagnose Pain

PainSci commentary on Kasch 2022: ?This page is one of thousands in the 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, a big “longitudinal” one: just observing the same group of people for a long time. We don’t see a lot of those in back pain research, or of this size/duration: about 3300 people over six years. But it gives us insight into the order of things, producing what I think is probably 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 they 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 great new data that really drives the old point home that most back pain is not caused by spines that are cruddy with arthritis.

~ Paul Ingraham

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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