Defensive medicine and MRI for back pain

• Mar 6, 2021 • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Dr. Christopher Labos and Jonathan Jarry, hosts of The Body of Evidence podcast, have been working with illustrator Luc Ouellet to produce a series of cartoons about key concepts in health science literacy. The ninth in the series is the first that’s directly about the world of pain and musculoskeletal medicine, highlighting “defensive medicine”, also known as “reason #127 why overtesting happens”: doctors are afraid of getting criticized or even sued for not ordering MRIs in search of an explanation for back pain.

Great work! A good dramatization of one aspect of the problem of excessive/premature imaging for back pain. There are several more, and they gang up on clinicians, virtually guaranteeing more MRI’ing than the world actually needs. See 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.

Here’s the whole series so far. While most aren’t directly relevant to what I do here, most are at least tangentially relevant, and they’re all worthwhile: