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MRI use versus abuse

 •  • 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 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. James Noake is the kind of expert clinician who reminds me that I am “just a writer,” and not an expert myself. He recently kicked a hornet’s nest with this extremely controversial tweet, netting a whopping 719 retweets and 2,459 likes:

“I use MRI in lower back pain 🤭”

That’s it? How does that get so much attention? Well, there was more: it was a tweet thread with a dozen parts. But it was hot hot hot because he was pushing back against a strong trend. For years now, it has been fashionable — for good, evidence-based reasons — to rail against the overuse of MRI. I have a whole article like that. But my article also says:

MRI especially is a miracle technology, no doubt about it — the ability to get clear images of soft tissues deep inside the body is valuable, and extremely tempting for everyone involved. MRI can shine when it’s actually needed and done well.

I have gotten angry email about that article calling me out both for praising MRI and for demonizing it’s abuse. So I was not surprised to see the poopstorm caused by Dr. Noake’s tweet, even though he was really just saying that MRI can shine.

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